Enoxaparin Dosing for Peripheral Artery Disease (PAD)
For patients with Peripheral Artery Disease (PAD), the recommended dose of enoxaparin is 1 mg/kg subcutaneously every 12 hours, or 0.5 mg/kg intravenously as a bolus for endovascular interventions. 1
Standard Dosing Regimens
- For patients undergoing endovascular interventions for PAD, an intravenous bolus of 0.5 mg/kg enoxaparin has been shown to be more effective than unfractionated heparin, with lower rates of thromboembolism and bleeding complications 1
- For general prophylaxis in PAD patients, enoxaparin 40 mg subcutaneously once daily is typically used 2
- For therapeutic anticoagulation in PAD patients, enoxaparin 1 mg/kg subcutaneously every 12 hours is the standard dose 2
Dosage Adjustments
- In patients with renal impairment (creatinine clearance <30 mL/min), the dose should be reduced to 1 mg/kg subcutaneously once daily 2
- For elderly patients ≥75 years, dose reduction may be necessary to 0.75 mg/kg subcutaneously every 12 hours 2
- Obese patients may require higher doses; weight-based dosing of 0.5 mg/kg subcutaneously every 12 hours may be more appropriate than fixed dosing 2
Monitoring and Efficacy
- Anti-Xa levels can be monitored to ensure adequate anticoagulation, particularly in critically ill patients who may have altered drug absorption from subcutaneous sites 3
- Subprophylactic anti-Xa trough levels are common in trauma patients and may require dose adjustments to achieve target levels 4
- Target anti-Xa levels should be reached within 15 minutes of administration; this occurs more reliably with enoxaparin (63.7%) compared to unfractionated heparin (39.1%) 1
Clinical Considerations for PAD Patients
- Enoxaparin has better bioavailability, longer half-life, more predictable anticoagulation effect, less bleeding risk, and lower risk of heparin-induced thrombocytopenia compared to unfractionated heparin 2
- In patients with concomitant use of aspirin, enoxaparin shows significantly fewer complications compared to unfractionated heparin 1
- For patients undergoing percutaneous interventions for PAD, intravenous enoxaparin may be considered as an alternative to unfractionated heparin to reduce ischemic events 2
Cautions and Contraindications
- Avoid switching between enoxaparin and unfractionated heparin due to increased bleeding risk 2
- Fondaparinux should not be used to support percutaneous interventions because of the risk of catheter thrombosis 2
- For patients with high bleeding risk but requiring anticoagulation, bivalirudin may be considered as an alternative 2
Duration of Therapy
- For acute interventions, enoxaparin is typically administered during the procedure and continued for 24-48 hours post-procedure 1
- For long-term management, the duration should be determined based on clinical indication and patient risk factors 2
- Once daily dosing regimens (1.5 mg/kg) may be associated with higher rates of recurrent thromboembolism compared to twice daily dosing (1 mg/kg) in high-risk patients 5