What is the dose of Enoxaparin (Lovenox) for anticoagulation?

From the Guidelines

The recommended dose of Enoxaparin (Lovenox) for anticoagulation is 1 mg/kg subcutaneously every 12 hours, with a reduced dose of 1 mg/kg subcutaneously once daily in patients with creatinine clearance <30 mL/min. This dosing regimen is based on the most recent and highest quality evidence from the 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes 1, 2.

Key Considerations

• The dose of enoxaparin should be adjusted in patients with impaired renal function, with a creatinine clearance <30 mL/min requiring a reduced dose of 1 mg/kg subcutaneously once daily 1, 2.
• An initial intravenous loading dose of 30 mg may be used in selected patients, followed by 1 mg/kg subcutaneously every 12 hours 1, 2.
• Enoxaparin has been shown to be effective in reducing recurrent ischemic events and invasive diagnostic and therapeutic procedures in patients with non-ST-elevation acute coronary syndromes 1.

Administration and Monitoring

• Enoxaparin should be administered via subcutaneous injection in the abdominal wall, alternating sides, with the patient seated or lying down.
• Patients should be monitored for bleeding complications and periodic platelet counts should be considered to detect heparin-induced thrombocytopenia, especially in the first two weeks of therapy.

Special Populations

• Obese patients may require dose capping or weight-based adjustments.
• Pregnant patients generally receive weight-based dosing.
• Patients with severe renal impairment may require alternative anticoagulation therapy, such as unfractionated heparin.

From the FDA Drug Label

PACKAGE LABEL.PRINCIPAL DISPLAY PANEL NDC 11797-757-06 Enoxaparin Sodium Injection USP 30 mg/0.3 mL SINGLE-DOSE SYRINGES WITH AUTOMATIC SAFETY DEVICE FOR SUBCUTANEOUS INJECTION Ten 0.3 mL Syringes NDC 11797-758-06 Enoxaparin Sodium Injection USP 40 mg/0.4 mL SINGLE-DOSE SYRINGES WITH AUTOMATIC SAFETY DEVICE FOR SUBCUTANEOUS INJECTION Ten 0. 4 mL Syringes 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 NDC 11797-760-06 Enoxaparin Sodium Injection USP 80 mg/0.8 mL SINGLE-DOSE SYRINGES WITH AUTOMATIC SAFETY DEVICE FOR SUBCUTANEOUS INJECTION Ten 0. 8 mL Syringes NDC 11797-761-06 Enoxaparin Sodium Injection USP 100 mg/1 mL SINGLE-DOSE SYRINGES WITH AUTOMATIC SAFETY DEVICE FOR SUBCUTANEOUS INJECTION Ten 1 mL Syringes NDC 11797-762-06 Enoxaparin Sodium Injection USP 120 mg/0.8 mL SINGLE-DOSE SYRINGES WITH AUTOMATIC SAFETY DEVICE FOR SUBCUTANEOUS INJECTION Ten 0. 8 mL Syringes NDC 11797-763-06 Enoxaparin Sodium Injection USP 150 mg/1 mL SINGLE-DOSE SYRINGES WITH AUTOMATIC SAFETY DEVICE FOR SUBCUTANEOUS INJECTION Ten 1 mL Syringes

The FDA drug label does not answer the question.

From the Research

Enoxaparin Dosing for Anticoagulation

The dose of Enoxaparin (Lovenox) for anticoagulation varies depending on the patient's condition and renal function.

• For patients with ST-segment elevation myocardial infarction, the dose is an initial 30 mg intravenous bolus, followed by 1 mg/kg subcutaneously within 15 minutes and then every 12 hours for up to 8 days, with the first two subcutaneous dosages not to exceed 100 mg 3.
• For patients older than 75 years, the initial bolus is not given, and the 12-hourly dosages are reduced to 0.75 mg/kg 3.
• For patients with an estimated creatinine clearance of less than 30 mL/min, the dose is reduced to 1 mg/kg every 24 hours 3.
• For symptomatic pulmonary embolism, the dose is 1 mg/kg twice daily for 14 days during the acute phase, followed by 1.0 mg/kg or 1.5 mg/kg once daily during the chronic phase 4.
• For venous and arterial thromboembolism, the dose ranges from fixed doses of 20-60 mg once daily and 0.75-1.5 mg/kg twice daily 5.
• For elderly patients with renal failure, the dose of enoxaparin ranges between 53 and 200 U/kg, with a total of 4000-16000 U/day 6.
• For critically ill patients with venous thromboembolism, the dose is 1 mg/kg twice daily or 1.5 mg/kg daily, with dose adjustments required in 70.7% to 83.3% of patients to achieve optimal anti-Xa levels 7.