India · DVT Treatment · ACS · Surgical Prophylaxis · Pregnancy · Renal Adjustment · Obesity · Clexane · Lonopin · Enoxalow
Treatment BD: 0.6–1.0 IU/mL at 4h post-dose
Treatment OD: 1.0–2.0 IU/mL at 4h post-dose
Prophylaxis: 0.2–0.4 IU/mL at 4h post-dose
Pregnancy treatment: 0.6–1.0 IU/mL BD
Monitor: obesity (>100kg), pregnancy, CrCl <30
| Indication | Dose | Frequency | Duration | Anti-Xa monitoring |
|---|---|---|---|---|
| DVT / PE treatment | 1 mg/kg SC | Every 12 hours (BD) | 5 days minimum, overlap with warfarin/DOAC | If wt >100kg, CrCl <30, or pregnancy |
| DVT treatment (OD option) | 1.5 mg/kg SC | Once daily (OD) | As above | Target 1.0–2.0 IU/mL at 4h |
| NSTEMI / UA | 1 mg/kg SC | Every 12 hours (BD) | 2–8 days (until PCI or discharge) | Not routine (adjust for renal) |
| STEMI + thrombolysis | 30mg IV bolus then 1mg/kg SC BD (age <75); 0.75mg/kg SC BD no bolus (age ≥75) | BD | 8 days or until PCI | CrCl <30: 1mg/kg OD |
| Surgical prophylaxis (moderate) | 20–40 mg SC | Once daily | 7–10 days (or until ambulatory) | Not routine |
| Orthopaedic VTE prophylaxis | 40 mg SC | Once daily | Hip: 28–35 days; Knee: 10–14 days | Not routine (unless CrCl <30) |
| Medical VTE prophylaxis | 40 mg SC | Once daily | Hospital stay (min 6–14 days) | If CrCl <30: 20mg OD |
| Pregnancy — treatment dose | 1 mg/kg SC BD | Every 12 hours | Throughout pregnancy + 6 weeks postpartum | Anti-Xa each trimester: target 0.6–1.0 |
| Pregnancy — prophylaxis | 40 mg SC | Once daily | Antepartum + 6 weeks postpartum | Anti-Xa if wt >90kg |
Enoxaparin (Clexane, Lonopin, Enoxalow) is the most widely used low molecular weight heparin (LMWH) in Indian hospitals for prevention and treatment of venous thromboembolism (VTE), acute coronary syndromes, and anticoagulation in pregnancy. Compared to unfractionated heparin (UFH), enoxaparin offers predictable pharmacokinetics with subcutaneous once or twice daily dosing, no requirement for APTT monitoring in most patients, and a lower risk of heparin-induced thrombocytopenia (HIT).
Enoxaparin is predominantly renally cleared. In severe renal impairment (CrCl <30 mL/min), enoxaparin accumulates significantly, with a substantially increased risk of major bleeding. For treatment indication: reduce from 1 mg/kg BD to 1 mg/kg once daily. For prophylaxis: reduce from 40 mg OD to 20 mg OD. Anti-Xa monitoring is strongly recommended in all patients with CrCl <30. Enoxaparin should be avoided or used with extreme caution in end-stage renal disease (CrCl <10) — unfractionated heparin (UFH) monitored by APTT is a safer alternative in dialysis patients.
For obese patients (BMI >40 or weight >120 kg), use actual body weight for enoxaparin calculation but anti-Xa monitoring is recommended. Most guidelines suggest not exceeding 150–180 mg per dose (for therapeutic BD dosing) without monitoring. Prophylactic dose in morbid obesity: 40 mg BD (rather than OD) is often used, though evidence is limited. Check anti-Xa levels 4 hours post-dose; target 0.6–1.0 IU/mL for therapeutic BD dosing.
Enoxaparin does not cross the placenta and is safe throughout pregnancy. It is the anticoagulant of choice for VTE treatment, VTE prophylaxis, and mechanical heart valve anticoagulation (with UFH or specialist input) in pregnancy. Dose requirements increase as pregnancy progresses due to weight gain, increased renal clearance, and volume of distribution changes — anti-Xa monitoring is recommended at least once per trimester for therapeutic doses. Stop enoxaparin 12–24 hours before planned delivery (24 hours if therapeutic dose) and do not restart for 4–6 hours post-delivery or 12 hours after spinal/epidural anaesthesia removal.