When is Enoxaparin (Low Molecular Weight Heparin) contraindicated?

From the Guidelines

Enoxaparin is contraindicated in patients with active major bleeding, history of immune-mediated heparin-induced thrombocytopenia (HIT), or hypersensitivity to enoxaparin, heparin, or any component of the formulation. The contraindications for enoxaparin use are based on the potential for serious bleeding complications in high-risk patients or when used in situations where bleeding risk is elevated 1.

Specific Contraindications

• Active major bleeding at any site, tissue, or organ
• History of immune-mediated heparin-induced thrombocytopenia (HIT) within the past 100 days
• Presence of anti-platelet factor 4/heparin antibodies
• Hypersensitivity to enoxaparin, heparin, pork products, or any component of the formulation
• Severe renal impairment (creatinine clearance <30 mL/min) is a relative contraindication for therapeutic dosing, requiring dose adjustment 1

Precautions and Warnings

• Enoxaparin should be used cautiously in patients with recent history of ischemic stroke, uncontrolled hypertension, diabetic retinopathy, or conditions associated with increased bleeding risk 1
• For spinal/epidural anesthesia or spinal puncture, enoxaparin is contraindicated when used at therapeutic doses in patients receiving scheduled twice daily dosing due to increased risk of spinal hematoma 1
• Patients with thrombocytopenia should be actively monitored while receiving enoxaparin 1
• Enoxaparin should be used with caution in patients with liver failure or elevated INR 1

Dosing Considerations

• The dosing regimen for enoxaparin should be adjusted based on renal function, with a reduced dose recommended for patients with creatinine clearance <30 mL/min 1
• The use of enoxaparin in patients with severe renal impairment should be carefully considered, with close monitoring of anti-Xa levels and adjustment of the dose as needed 1

From the Research

Contraindications of Enoxaparin

• Enoxaparin is contraindicated in patients with severe renal insufficiency, as it may increase the risk of bleeding complications 2, 3.
• Patients with a history of heparin-induced thrombocytopenia should not be treated with enoxaparin 4.
• Enoxaparin should be used with caution in patients over 75 years of age, as they may be at a higher risk of bleeding events 3.
• Patients with active bleeding or a high risk of bleeding should not be treated with enoxaparin.
• Enoxaparin may also be contraindicated in patients with a known hypersensitivity to enoxaparin or other low molecular weight heparins.

Special Considerations

• In patients with severe thrombocytopenia, enoxaparin can be used safely at reduced dosages 5.
• Enoxaparin-induced reactive thrombocytosis is a rare adverse reaction, and patients should be monitored for signs of thrombocytosis while receiving enoxaparin 6.