From the Guidelines

Yes, lovenox (enoxaparin) can cause thrombocytopenia, but the risk is low.

Thrombocytopenia is a potential side effect of heparin therapy, including low molecular weight heparin (LMWH) such as enoxaparin 1.
The risk of HIT with LMWH is lower compared to unfractionated heparin (UFH), with an incidence of approximately 0.2% in medical patients treated with preventive doses of LMWH 1.
A study in 2005 reported an incidence of HIT of 0.8% under LMWH at preventive or curative doses, but this result has not been confirmed 1.
In obstetrics, a systematic review of more than 2700 pregnancies under LMWH confirmed a very low risk of HIT, less than 0.1% 1.

The risk of HIT varies depending on the clinical context, with a higher risk in patients undergoing orthopedic surgery or cardiac surgery with cardiopulmonary bypass (CPB) 1.
In medical patients, the risk of UFH-related HIT is probably lower but remains close to 1% 1.
Patients on extracorporeal membrane oxygenation (ECMO) require curative anticoagulant treatment with intravenous UFH and therefore have a high risk of HIT 1.

Platelet count monitoring is not indicated for most patients treated with LMWH, such as enoxaparin, due to the low risk of HIT 1.
Discontinuing heparin therapy and switching to a nonheparin anticoagulant is the critical step in the management of HIT 1.
Approved alternative anticoagulants include direct thrombin inhibitors such as argatroban and bivalirudin or heparinoids such as danaparoid 1.

From the Research

Enoxaparin, a low molecular weight heparin, can cause thrombocytopenia, as reported in several studies 2, 3, 4, 5.
Thrombocytopenia is a severe side effect of heparin administration, and it is more frequent in patients treated with unfractionated heparin, but it can also be induced by low molecular weight heparin 3.
The detection of platelet antibodies and the recovery of platelet count after cessation of enoxaparin strongly support the diagnosis of heparin-induced thrombocytopenia (HIT) 3.
Monitoring the platelet count is essential for early diagnosis of HIT, and all patients who undergo heparinization should have a baseline platelet count done before the regimen is started and should be monitored closely, especially during the first weeks of treatment 5.

A case report described a patient who developed enoxaparin-associated thrombocytosis, which was completely resolved after treatment cessation 2.
Another case report presented a patient who developed large, multiple, painful lesions induced by enoxaparin administration, but laboratory investigations for HIT were negative 6.
A case of heparin-induced thrombocytopenia was reported in a patient treated with enoxaparin, with a detailed platelet count analysis over time and detection of platelet antibodies 3.
A patient was reported to have severe enoxaparin-induced thrombocytopenia complicated by pulmonary emboli, with a positive test for antibodies against heparin 4.
A case of low molecular weight heparin-induced thrombocytopenia (HIT) causing stroke, lower extremity arterial occlusion, and skin necrosis was also reported 5.