From the Guidelines
Enoxaparin is a type of low molecular weight heparin (LMWH), which is distinct from unfractionated heparin (UFH) due to its smaller molecular size and balanced anti-Xa and anti-IIa activity. According to the 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes 1, LMWHs like enoxaparin have several advantages over UFH, including less platelet activation and no requirement for routine monitoring of anticoagulant activity.
The key characteristics of enoxaparin include:
- Molecular weight approximately one third that of UFH
- Balanced anti-Xa and anti-IIa activity
- Readily absorbed after subcutaneous administration
- Less platelet activation compared to UFH
- No requirement for routine monitoring of anticoagulant activity 1
In clinical practice, enoxaparin is commonly used to prevent and treat deep vein thrombosis, pulmonary embolism, and in certain cardiac conditions, with a typical dose of 1 mg/kg SC every 12 hours for NSTE-ACS, and an initial intravenous loading dose of 30 mg in selected patients 1. However, in patients with impaired renal function (CrCl <30 mL per minute), the dose should be reduced to 1 mg/kg SC once daily, and strong consideration should be given to UFH as an alternative 1.
Overall, enoxaparin offers a predictable dose response, requires less monitoring, and can be administered subcutaneously, making it a convenient and effective anticoagulant option in various clinical settings, as supported by studies such as the ESSENCE and SYNERGY trials 1.
From the Research
Definition and Classification of Enoxaparin
- Enoxaparin is a low-molecular-weight heparin (LMWH) 2, 3, 4.
- It is derived from unfractionated heparin and has a lower average molecular weight of approximately 4500 daltons compared to heparin's 12,000-15,000 daltons 3.
Comparison with Unfractionated Heparin
- Enoxaparin has several advantages over unfractionated heparin, including a more predictable anticoagulant effect and easier administration 3, 4, 5.
- Enoxaparin does not form a complex with antithrombin III and thrombin as extensively as heparin, but has similar anti-Xa activity 3.
- Studies have shown that enoxaparin is more effective in suppressing ongoing thrombosis in vivo than unfractionated heparin in patients with venous thromboembolism 6.
Clinical Use of Enoxaparin
- Enoxaparin is used to prevent and treat venous thromboembolism, as well as in patients with acute coronary syndromes 2, 3, 5.
- It has been shown to be safe and effective in these conditions, with similar efficacy and safety to unfractionated heparin in some cases 2, 5.
- Enoxaparin may have a lower incidence of bleeding complications compared to unfractionated heparin, although it can cause minor bleeding such as ecchymoses at injection sites 5.