From the Guidelines
The maximum dose of Clexane (enoxaparin) for deep vein thrombosis (DVT) and pulmonary embolism (PE) is 1 mg/kg twice daily or 1.5 mg/kg once daily, as indicated in the most recent guidelines 1. For most patients, this means a maximum of 150 mg twice daily or 150 mg once daily, as doses are typically capped at this level even for heavier patients. Treatment duration is usually 5-10 days for acute management, followed by transition to oral anticoagulants for at least 3 months, though this varies based on whether the clot was provoked or unprovoked. Key considerations in dosing enoxaparin include:
- Renal function, with dose reductions needed for patients with creatinine clearance below 30 ml/min, as emphasized in 1.
- Monitoring of platelet counts due to the small risk of heparin-induced thrombocytopenia, especially in the first 10 days of treatment. The mechanism of action of enoxaparin involves enhancing antithrombin III activity, which inhibits factors Xa and IIa in the coagulation cascade, preventing further clot formation while the body naturally dissolves existing clots, as supported by the pharmacological principles underlying its use 1. It's crucial to follow the most recent guidelines for the management of DVT and PE, considering factors such as patient weight, renal function, and the presence of other risk factors that may influence the choice of anticoagulant and its dosing, as outlined in 1.
From the Research
Maximum Dose of Clexane (Enoxaparin)
The maximum dose of Clexane (enoxaparin) for deep vein thrombosis and pulmonary embolism is not explicitly stated in the provided studies. However, the following information can be gathered:
- The standard dose of enoxaparin for the prevention of venous thromboembolism is 40 mg subcutaneously once daily 2.
- For the treatment of acute pulmonary embolism, enoxaparin can be administered at a dose of 1 mg/kg subcutaneously twice daily or 1.5 mg/kg subcutaneously once daily 3.
- The efficacy and safety of enoxaparin versus unfractionated heparin for the prevention of venous thromboembolism after acute ischemic stroke were compared in the PREVAIL study, which used a dose of 40 mg subcutaneously once daily 4.
Key Points
- Enoxaparin is a low-molecular-weight heparin that binds to and increases the activity of antithrombin III, inhibiting prothrombinase-mediated thrombin generation and direct thrombin generation by binding to factor Xa and thrombin factor IIa 2.
- The use of enoxaparin as prophylaxis in medically ill patients at increased risk for thromboembolism has shown significantly increased efficacy compared with placebo in reducing the incidence of deep vein thrombosis and pulmonary embolism 2.
- Enoxaparin has been compared to unfractionated heparin in several studies, with results suggesting that enoxaparin may be preferable due to its better clinical benefits to risk ratio and convenience of once daily administration 5, 4.
Dosage Considerations
- The dosage of enoxaparin may vary depending on the specific indication and patient population.
- The maximum dose of enoxaparin is not explicitly stated in the provided studies, but the standard doses mentioned above can be used as a reference.
- It is essential to consult the prescribing information and relevant clinical guidelines for specific dosage recommendations 6, 3.