Enoxaparin Dosing for Deep Vein Thrombosis (DVT)
The recommended dose of enoxaparin for treatment of DVT is 1 mg/kg subcutaneously every 12 hours. 1
Standard Dosing Regimen
- Enoxaparin 1 mg/kg subcutaneously every 12 hours is the standard therapeutic dosing regimen for DVT treatment 1, 2
- Alternative regimen: 1.5 mg/kg once daily (though this regimen has been less extensively studied in cancer patients) 3, 4
- Treatment should continue for at least 5-10 days and until adequate oral anticoagulation is established if transitioning to warfarin 1
Special Populations and Dose Adjustments
Renal Impairment
- For severe renal insufficiency (creatinine clearance <30 mL/min): Reduce dose to 1 mg/kg once daily 2
- Monitor anti-Xa levels in patients with compromised renal function (target peak levels: 0.5-1.2 IU/mL) 2
Obesity
- Standard weight-based dosing (1 mg/kg twice daily) should be used
- For patients with class III obesity (BMI >40), some evidence suggests considering 0.5 mg/kg twice daily for prophylaxis, but therapeutic dosing remains weight-based 2
Monitoring Requirements
- Baseline laboratory testing: Complete blood count (CBC), renal and hepatic function panel, aPTT, and PT/INR 1
- Follow-up monitoring: Hemoglobin, hematocrit, and platelet count at least every 2-3 days for the first 14 days and every 2 weeks thereafter 1
- Monitor for signs of bleeding or heparin-induced thrombocytopenia 2
Duration of Treatment
- For cancer patients with DVT: Extended treatment for at least 6 months is recommended 1, 2
- For patients transitioning to warfarin: Continue enoxaparin until INR ≥2 for 24 hours 1
- For patients transitioning to edoxaban: Complete at least 5 days of enoxaparin before switching 1
Combination Therapy Options
If transitioning to oral anticoagulation:
Enoxaparin + Warfarin:
- Enoxaparin 1 mg/kg SC every 12 hours
- Warfarin 2.5-5 mg daily initially (subsequent dosing based on INR; target INR 2-3)
- Continue both until INR ≥2 for 24 hours 1
Enoxaparin + Edoxaban:
- Enoxaparin 1 mg/kg SC every 12 hours for at least 5 days
- Then switch to edoxaban 60 mg daily (or 30 mg in patients with CrCl 30-50 mL/min, weight <60 kg, or on certain medications) 1
Practical Considerations
- Select regimen based on: renal function, inpatient/outpatient status, bleeding risk, and ability to reverse anticoagulation 1
- Enoxaparin offers advantages over unfractionated heparin including more predictable pharmacokinetics and no need for routine coagulation monitoring in most patients 3
- Subcutaneous administration allows for outpatient treatment in appropriate candidates 4
Common Pitfalls to Avoid
- Underdosing in obese patients (use actual body weight for calculations)
- Failure to adjust dose in severe renal impairment
- Inadequate monitoring in high-risk patients
- Premature discontinuation before therapeutic oral anticoagulation is established
- Failure to monitor for heparin-induced thrombocytopenia, especially in patients with history of this condition 2