From the Guidelines
Enoxaparin 0.6 cc is indicated for the prevention of venous thromboembolism (VTE) in patients with multiple risk factors such as diabetes mellitus, hypertension, and heart failure, and its mechanism of action involves binding to antithrombin III to inactivate coagulation factors Xa and IIa. The patient's conditions, including diabetes mellitus, hypertension, and heart failure, create a hypercoagulable state that increases the risk of clot formation, making enoxaparin a suitable choice for VTE prevention. According to the 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes 1, low-molecular-weight heparins like enoxaparin have balanced anti-Xa and anti-IIa activity and are readily absorbed after subcutaneous administration. Key points to consider when administering enoxaparin to this patient include:
- The typical prophylactic dose is 40 mg (0.4 cc) once daily, but 60 mg (0.6 cc) may be used for treatment of established VTE or for prophylaxis in higher-risk patients.
- Enoxaparin should be administered subcutaneously, preferably in the abdominal wall.
- Renal function should be monitored, as dose adjustments are needed if creatinine clearance is below 30 ml/min, a common finding in older patients or those with impaired renal function 1.
- Blood counts should be checked periodically to monitor for thrombocytopenia, a potential side effect. Compared to unfractionated heparin, enoxaparin offers more predictable dosing, less frequent monitoring requirements, and a lower risk of heparin-induced thrombocytopenia while effectively reducing the risk of dangerous clot formation in these high-risk patients, as demonstrated in trials such as the ESSENCE and SYNERGY trials 1.
From the FDA Drug Label
PACKAGE LABEL.PRINCIPAL DISPLAY PANEL NDC 11797-759-06 Enoxaparin Sodium Injection USP 60 mg/0.6 mL SINGLE-DOSE SYRINGES WITH AUTOMATIC SAFETY DEVICE FOR SUBCUTANEOUS INJECTION Ten 0.6 mL Syringes The indication of Enoxaparin 0.6 cc is not explicitly stated in the provided drug label for a patient with diabetes mellitus, hypertension, and heart failure. The mechanism of action of Enoxaparin is also not mentioned in the label. 2
From the Research
Indication of Enoxaparin
- Enoxaparin is indicated for the prevention of deep vein thrombosis and pulmonary embolism in patients undergoing orthopaedic or general surgery 3.
- It is also used in the treatment of unstable angina and non-Q wave coronary events 3.
- In patients with diabetes mellitus, hypertension, and heart failure, enoxaparin may be used to reduce the risk of death, myocardial infarction, or recurrent angina 4.
Mechanism of Action
- Enoxaparin is a low molecular weight heparin (LMWH) that works by inhibiting the coagulation factor Xa, thereby preventing the formation of blood clots 3.
- It has a high affinity for antithrombin III, which enhances its anticoagulant activity 5.
- The mechanism of action of enoxaparin is similar to that of unfractionated heparin, but it has a more predictable and stable anticoagulant effect 3.
Dosage and Administration
- The dosage of enoxaparin is typically 0.6 cc (40 mg) subcutaneously once daily for the prevention of deep vein thrombosis and pulmonary embolism 3.
- In patients with renal impairment, the dosage of enoxaparin may need to be adjusted to achieve therapeutic anti-Xa levels 6.
- Weight-based dosing of enoxaparin may be used in obese patients to ensure therapeutic drug levels 7.
Efficacy and Safety
- Enoxaparin has been shown to be effective in reducing the risk of death, myocardial infarction, or recurrent angina in patients with unstable angina and non-Q wave coronary events 3.
- It has also been shown to be effective in preventing deep vein thrombosis and pulmonary embolism in patients undergoing orthopaedic or general surgery 3.
- The safety of enoxaparin is similar to that of unfractionated heparin, with a low risk of major bleeding complications 3, 4.