What is the recommended dose of Lovenox (enoxaparin) for prophylaxis of Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)?

Enoxaparin Dosing for DVT and PE Prophylaxis

For DVT and PE prophylaxis, the recommended dose of enoxaparin is 40 mg subcutaneously once daily for most patients. 1

Standard Prophylactic Dosing

• Enoxaparin 40 mg subcutaneously once daily is the standard prophylactic dose for most hospitalized patients at risk of DVT/PE 1
• Duration should be for the length of hospital stay or until fully ambulatory for medical patients, and at least 7-10 days for surgical patients 1
• Enoxaparin offers advantages over unfractionated heparin including better bioavailability, longer half-life, more predictable anticoagulation effect, and lower risk of heparin-induced thrombocytopenia 1

Special Population Dose Adjustments

Renal Impairment

• For patients with severe renal impairment (creatinine clearance <30 mL/min), reduce the dose to 30 mg subcutaneously once daily 1, 2
• Renal clearance of enoxaparin is reduced by 31% in moderate renal impairment and 44% in severe renal impairment 1
• Not adjusting the dose in patients with renal impairment can lead to drug accumulation and increased bleeding risk 1

Obesity

• For patients with obesity (BMI >30 kg/m²), consider intermediate doses (40 mg subcutaneously every 12 hours) or weight-based dosing (0.5 mg/kg subcutaneously every 12 hours) 1
• Standard fixed dosing may be inadequate in obese patients and excessive in very low-weight patients 1

Timing of Administration

• For surgical patients, enoxaparin should be started 2-4 hours preoperatively or 10-12 hours preoperatively 1
• Avoid administration within 10-12 hours before neuraxial anesthesia to reduce risk of spinal hematoma 1

Therapeutic Dosing (for Treatment of Established VTE)

• For treatment of established DVT/PE (not prophylaxis), the recommended doses are:
  • 1.0 mg/kg subcutaneously every 12 hours 3, 4
  • 1.5 mg/kg subcutaneously once daily 3, 5
• In patients with cancer requiring extended treatment, enoxaparin 1 mg/kg twice daily or 1.5 mg/kg once daily is recommended 3

Monitoring Recommendations

• Routine monitoring of anti-Xa levels is not required for prophylactic dosing in most patients 1
• For patients with severe renal impairment on prolonged therapy, consider monitoring anti-Xa levels with a target range of 0.5-1.5 IU/mL 1
• Anti-Xa levels should be measured 4-6 hours after dosing, after the patient has received 3-4 doses 1
• Regular monitoring of platelet count is necessary during treatment due to risk of heparin-induced thrombocytopenia 3

Common Pitfalls and Caveats

• Failure to properly time enoxaparin administration with spinal/epidural procedures can increase the risk of spinal hematoma 1
• Concomitant use with other antiplatelet or anticoagulant medications increases bleeding risk 1, 2
• For patients at very high bleeding risk, consider mechanical prophylaxis with intermittent pneumatic compression devices instead of pharmacological prophylaxis 2