Classification : Low molecular weight heparins

The mechanism of action is antithrombin-dependant[18]

The major way is by increasing antithrombin III – mediated inhibition of activity and formation of factor Xa. This will reduce the thrombin generation. Next, thrombin-mediated events in coagulation including conversion of fibrinogen to fibrin will be decreased. Consequently, fibrin clot formation is inhibited.[19]

Prevention  & treatment of venous thromboembolism[8]

Prevent clotting during extracorporeal circulation ( haemodialysis )

Stabilise unstable angina

Prevention of deep vein thrombosis(DVT)[20]

Use with warfarin for outpatient treatment of acute DVT not having Pulmonary Embolism[20]

Used for systemic anticoagulation [20]

Prevention of theromboembolic recurrence[20]

Used to prevent blood clot in haemodailysis or haemofiltration[8]

Management of unstable angina[8]

The only available route is deep subcutaneous ( Infratat ) injection into abdominal fat layer. No intramuscular or intravenous administration. The injection sites need to be rotated. [20]

The adult dose for acute illness is subcutaneous 40 mg every day for 6 to 11 days, up to 14 days. [20]

Dose depends on uses

For treatment of venous thromboembolism, dose 1000 units/kg by sc injection every 12 hours until optimum anticoagulant effect[8]

For unstable angina, it is given sc of 1mg/kg or 100units/kg for every 12 hours, continue to at least a week together with aspirin[17]

Use with care in elderly and patients with renal failure; creatinine clearance < 30ml/minute[13]

Patients with recent or anticipated epidural or spinal anesthesia are at risk of spinal & epidural hemitoma and consequent paralysis when using this drug[13]

i. Enoxaparin – spinal anesthesia
Use of enoxaparin with spinal anesthesia has been reported to cause neuraxial hemotoma which lead to long-term or permanent paralysis[17]

ii. Dalteparin- Platelet Inhibitors
Usage of enoxaparin with use of platelet inhibitors and other anticoagulant increases risk of bleeding[1]

iii. Enoxaparin – Non-Steroid Anti Inflammatory Drugs (NSAIDs)
Not compatible and will increase risk of bleeding when using Enoxaparin with NSAIDs agent[3]

iv. Enoxaparin – Diclofenac
Increased risk of Hemorrhage when using Enoxaparin together with intravenous diclofenac[17]

Dose depends on uses

For treatment of venous thromboembolism, dose 1000 units/kg by sc injection every 12 hours until optimum anticoagulant effect[8]

For unstable angina, it is given sc of 1mg/kg or 100units/kg for every 12 hours, continue to at least a week together with aspirin[17]

Use with care in elderly and patients with renal failure; creatinine clearance < 30ml/minute[13]

Patients with recent or anticipated epidural or spinal anesthesia are at risk of spinal & epidural hemitoma and consequent paralysis when using this drug.[13]

Higher risk of bleeding for skinny patient ( women below 45kg, men below 57kg)[8]

Increased risk of bleeding in patients having kidney impairment[8]

Delayed elimination of Enoxaparin in elderly patient. High risk of bleeding[8]

Extreme caution in patient that has history of heparin-induced thrombocytopenia[20]

Should be avoided in patient having uncontrolled arterial hypotension[20]