From the Guidelines
The full DVT treatment dose of Lovenox (enoxaparin) is 1 mg/kg body weight administered subcutaneously every 12 hours, or alternatively, 1.5 mg/kg once daily. For example, a 70 kg patient would receive either 70 mg twice daily or 105 mg once daily. The medication should be injected into the subcutaneous tissue of the abdomen, alternating sides with each injection. Treatment typically continues for at least 5 days and until adequate oral anticoagulation with warfarin is established (INR 2-3), or for the full treatment course if using Lovenox as the sole anticoagulant.
Key Considerations
- Dose adjustments are necessary for patients with severe renal impairment (creatinine clearance <30 mL/min), where the dose should be reduced to 1 mg/kg once daily 1, 2.
- Lovenox works by enhancing the inhibitory effect of antithrombin on factor Xa and thrombin, preventing clot formation and extension.
- Regular monitoring of platelet counts is recommended due to the risk of heparin-induced thrombocytopenia, though this occurs less frequently with low molecular weight heparins like Lovenox compared to unfractionated heparin 3, 4.
Special Populations
- For patients with a body mass index ≥40 kg/m2, a reduced dose of 0.8 mg/kg every 12 hours may be considered 2.
- The efficacy and safety of Lovenox in patients with cancer have been confirmed in several studies, including the CLOT study and the Hokusai-VTE Cancer study 2, 5.
From the Research
Dosing of Lovenox (Enoxaparin) for Deep Vein Thrombosis (DVT)
- The full dose of Lovenox (Enoxaparin) for DVT is typically administered subcutaneously at a fixed dosage of 1.0 mg/kg of body weight twice daily or 1.5 mg/kg once daily 6.
- Another study suggests that a weight-based enoxaparin dosing regimen of 0.5 mg/kg subcutaneously every 12 hours may be effective in preventing DVT in hospitalized trauma patients 7.
- Enoxaparin 1 mg/kg every 12 hours has also been used in the treatment of venous thrombosis in patients after intracardiac catheter interventions, with a switch to warfarin after 7 days 8.
- In morbidly obese patients, a weight-based dosing protocol of enoxaparin 0.5 mg/kg given subcutaneously every 12 hours has been shown to be effective in achieving anti-factor Xa levels within the appropriate prophylactic range 9.
- The dosing of enoxaparin for ST-segment elevation myocardial infarction is slightly different, with 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 10.
Key Considerations
- The dosing of enoxaparin may vary depending on the patient's weight, age, and renal function.
- The dose of enoxaparin may need to be adjusted based on anti-factor Xa levels to ensure therapeutic efficacy and minimize the risk of bleeding.
- Enoxaparin has been shown to be effective in preventing recurrent symptomatic venous thromboembolic disease, with a similar safety profile to unfractionated heparin 6.