What is the standard dose of Clexane (enoxaparin) for prophylaxis on the wards?

Standard Clexane (Enoxaparin) Dosing for VTE Prophylaxis on the Wards

The standard prophylactic dose of Clexane (enoxaparin) on the wards is 40 mg subcutaneously once daily for most patients. 1

Dosing Considerations Based on Patient Population

General Medical/Surgical Patients

• Standard dose: 40 mg subcutaneously once daily for hospitalized medical and surgical patients 1
• Duration: Throughout hospitalization or until fully ambulatory; for surgical patients, continue for at least 7-10 days 1

Special Populations

Obese Patients

• For patients with class III obesity (BMI ≥40 kg/m²), consider intermediate dosing:
  • Option 1: 40 mg subcutaneously every 12 hours 1
  • Option 2: Weight-based dosing of 0.5 mg/kg subcutaneously every 12 hours 1, 2
• Recent evidence suggests adjusted dosing may reduce VTE risk in obese cancer patients without significantly increasing bleeding risk 2

Patients with Renal Impairment

• Consider unfractionated heparin instead of enoxaparin in patients with significant renal disease, as UFH is cleared by the reticuloendothelial system rather than renally 1

Cancer Patients

• Standard dose: 40 mg subcutaneously once daily 1
• Some guidelines suggest UFH 5000 units three times daily as an alternative for cancer patients 1

Timing Considerations with Neuraxial Anesthesia

• For patients who received neuraxial anesthesia:
  • Prophylactic doses (40 mg daily) may be started 4 hours after catheter removal but not earlier than 12 hours after the block was performed 1
  • Intermediate doses (40 mg twice daily) should be started 4 hours after catheter removal but not earlier than 24 hours after the block was performed 1

Clinical Advantages of Enoxaparin

• Compared to unfractionated heparin, enoxaparin offers:
  • Better bioavailability and longer half-life (4.1 hours vs 2.8 hours for dalteparin) 3, 4
  • More predictable anticoagulation effect 1
  • Lower risk of heparin-induced thrombocytopenia 1
  • Lower risk of osteopenia with prolonged use 1
  • Convenient once-daily administration 3

Common Pitfalls and Caveats

• Bleeding risk assessment should be performed before initiating prophylaxis 1
• In patients with significant intraoperative bleeding complications, consider delaying pharmacologic prophylaxis or using UFH (which has a shorter half-life and is reversible) 1
• Avoid using new oral anticoagulants (apixaban, rivaroxaban, dabigatran) for VTE prophylaxis in pregnant or postpartum patients due to insufficient data 1
• Monitor for minor bleeding complications such as wound hematomas, which are usually mild with prophylactic doses 1
• For patients with multiple risk factors for VTE, consider extended prophylaxis for up to 4 weeks after discharge in high-risk patients 1