What is the appropriate prophylactic or intermediate dosing of Lovenox (Enoxaparin) during the antepartum period for a patient with a history of pulmonary embolism?

From the Guidelines

Prophylactic and Intermediate Dosing of Lovenox (Enoxaparin) During Antepartum Period

The recommended prophylactic antepartum dosing of Lovenox (enoxaparin) for a patient with a history of pulmonary embolism is 40 mg subcutaneously once daily. For intermediate dosing, 40 mg subcutaneously twice daily may be considered, especially in obese women or those at higher risk of recurrent venous thromboembolism (VTE) 1.

• The choice of dosing should be individualized based on patient-specific risk factors, such as obesity, and clinical judgment 1.
• It is essential to continue prophylactic antepartum Lovenox dosing throughout pregnancy and consider transitioning to therapeutic dosing if there are concerns about recurrent VTE 1.
• Postpartum, the dosing may need to be adjusted based on the patient's risk of recurrent VTE and the presence of any other risk factors.
• Weight-based prophylactic dosing of 0.5 mg/kg subcutaneously every 12 hours may be considered for morbidly obese women, as it can result in anti-Xa levels that are more often within the desired prophylactic target range 1.

Overall, the management of patients with a history of pulmonary embolism during pregnancy requires careful consideration of the risks and benefits of different anticoagulation strategies, and dosing should be tailored to the individual patient's needs 1.

From the Research

Dosing of Lovenox (Enoxaparin) During the Antepartum Period

• The appropriate prophylactic or intermediate dosing of Lovenox (Enoxaparin) during the antepartum period for a patient with a history of pulmonary embolism is not directly stated in the provided studies.
• However, the studies suggest that enoxaparin can be used as a prophylactic treatment to reduce the risk of venous thromboembolism in patients with acute medical illnesses 2, 3.
• A study published in 1999 found that prophylactic treatment with 40 mg of enoxaparin subcutaneously per day safely and effectively reduces the risk of venous thromboembolism in patients with acute medical illnesses 2.
• Another study published in 2001 found that enoxaparin 1.0 mg/kg twice daily is as effective and safe as dose-adjusted, continuously infused unfractionated heparin in the prevention of recurrent symptomatic venous thromboembolic disease 4.
• A study published in 2005 investigated the efficacy and safety of extended enoxaparin monotherapy in symptomatic patients with acute pulmonary embolism and found that it is feasible and warrants further investigation in a large clinical trial 5.
• The dosing of enoxaparin in these studies varied, but the most common dosing regimens were 40 mg subcutaneously per day or 1.0 mg/kg twice daily.

Considerations for Antepartum Period

• The studies do not provide specific guidance on the dosing of enoxaparin during the antepartum period.
• However, the American College of Chest Physicians (ACCP) recommends that pregnant women with a history of venous thromboembolism receive prophylactic anticoagulation with low-molecular-weight heparin, such as enoxaparin, at a dose of 40 mg subcutaneously per day or 1.0 mg/kg twice daily 6.
• The ACCP also recommends that the dose of enoxaparin be adjusted based on the patient's weight and renal function.

Summary of Enoxaparin Dosing Regimens

• 40 mg subcutaneously per day 2, 3
• 1.0 mg/kg twice daily 4, 5
• 1.5 mg/kg once daily 4