What is the frequency of subcutaneous administration of Lovenox (enoxaparin)?

Frequency of Subcutaneous Lovenox (Enoxaparin) Administration

The standard frequency of subcutaneous Lovenox (enoxaparin) administration is twice daily (every 12 hours) at a dose of 1 mg/kg for most therapeutic indications. 1

Dosing Regimens Based on Clinical Indication

Standard Therapeutic Dosing

• Twice daily regimen: 1 mg/kg subcutaneously every 12 hours (standard therapeutic dose) 1
• Once daily regimen: 1.5 mg/kg subcutaneously once daily (alternative therapeutic dose) 2

Population-Specific Adjustments

• Elderly patients (≥75 years): 0.75 mg/kg subcutaneously every 12 hours 1, 3
• Renal impairment (CrCl <30 mL/min): 1 mg/kg subcutaneously once daily 1, 3
• Morbidly obese patients (BMI ≥40 kg/m²): Consider 0.8 mg/kg subcutaneously every 12 hours 1

Indication-Specific Dosing

Venous Thromboembolism (VTE) Treatment

• 1 mg/kg subcutaneously every 12 hours OR
• 1.5 mg/kg subcutaneously once daily 2
• Continue for at least 5 days and until adequate oral anticoagulation is established

Acute Coronary Syndrome

• Initial 30 mg IV bolus, followed by 1 mg/kg subcutaneously every 12 hours 3, 1
• For patients ≥75 years: No bolus, 0.75 mg/kg subcutaneously every 12 hours 3

Thromboprophylaxis in Medical Patients

• 40 mg subcutaneously once daily 4, 3
• Continue throughout hospitalization or until fully mobile

Thromboprophylaxis in Surgical Patients

• General surgery: 40 mg subcutaneously once daily 3
• Orthopedic surgery: 30 mg subcutaneously twice daily 3

Bridging Therapy (for patients on warfarin requiring procedures)

• Therapeutic dose: 1 mg/kg subcutaneously every 12 hours 3
• Last dose should be given at least 24 hours before procedure 3
• Resume 12-48 hours post-procedure based on bleeding risk 3

Important Clinical Considerations

Monitoring

• Routine monitoring of anti-Xa levels is not required for most patients 1
• Consider monitoring in patients with severe renal impairment, extreme body weights, or on prolonged therapy

Administration Technique

• Inject into abdominal wall, alternating sides
• Do not expel air bubble from prefilled syringes before injection
• Pinch skin fold during injection to minimize local bruising

Potential Complications

• Local reactions: Bruising, hematoma, or rarely tissue necrosis at injection sites 5
• Bleeding risk: Higher risk of minor bleeding compared to unfractionated heparin 6

Advantages Over Unfractionated Heparin

• More predictable anticoagulant response
• No routine laboratory monitoring required
• Longer half-life allowing once or twice daily dosing
• Lower risk of heparin-induced thrombocytopenia
• Subcutaneous administration versus continuous IV infusion 6, 7

When transitioning between anticoagulants, timing is critical to maintain adequate anticoagulation while minimizing bleeding risk. For example, when switching from apixaban to enoxaparin, start enoxaparin at the next scheduled apixaban dose time 1.