What is the therapeutic dose of Lovenox (enoxaparin)?

Therapeutic Dosing of Lovenox (Enoxaparin)

The standard therapeutic dose of enoxaparin is 1 mg/kg subcutaneously every 12 hours, with dose reduction to 1 mg/kg once daily in patients with creatinine clearance <30 mL/min. 1

Standard Dosing Regimens

• For most patients requiring therapeutic anticoagulation, the recommended dose is 1 mg/kg subcutaneously every 12 hours 1
• An initial intravenous loading dose of 30 mg has been used in selected patients 1
• Maximum dose for the first two subcutaneous doses is 100 mg 1, 2

Dose Adjustments for Special Populations

Renal Impairment

• For patients with severe renal impairment (CrCl <30 mL/min), reduce dose to 1 mg/kg subcutaneously once daily 1, 3
• Consider monitoring anti-Xa levels in patients with severe renal impairment, with a target therapeutic range of 0.5-1.0 IU/mL 3, 4
• Excessive accumulation can occur in patients with renal impairment if dose is not adjusted, increasing bleeding risk 4, 5

Elderly Patients

• For patients ≥75 years of age, omit the initial IV bolus and use 0.75 mg/kg subcutaneously every 12 hours (maximum 75 mg for the first 2 doses) 1, 6
• Elderly patients have higher bleeding risk and may require careful monitoring 3, 5

Specific Clinical Scenarios

Acute Coronary Syndromes

• For initial therapy in ACS: 1 mg/kg subcutaneously every 12 hours 1
• To support PCI:
  • If last subcutaneous dose was given 8-12 hours earlier, administer IV dose of 0.3 mg/kg 1
  • If last dose was within previous 8 hours, no additional enoxaparin needed 1
  • For patients without prior anticoagulant therapy, use 0.5-0.75 mg/kg IV bolus 1

With Fibrinolytic Therapy

• For patients <75 years: 30 mg IV bolus, followed in 15 minutes by 1 mg/kg subcutaneously every 12 hours (maximum 100 mg for first 2 doses) 1
• For patients ≥75 years: No bolus, use 0.75 mg/kg subcutaneously every 12 hours (maximum 75 mg for first 2 doses) 1
• Regardless of age, if CrCl <30 mL/min: 1 mg/kg subcutaneously every 24 hours 1

Pulmonary Embolism

• Standard dose of 1 mg/kg subcutaneously every 12 hours is recommended 7, 8
• Some studies suggest that cancer patients may have higher recurrence rates with once-daily dosing (1.5 mg/kg) compared to twice-daily dosing (1 mg/kg) 8

Monitoring and Safety Considerations

• Avoid switching between enoxaparin and unfractionated heparin due to increased bleeding risk 1, 6
• High-risk patients for bleeding include those with advanced age, renal impairment, low body weight, and those receiving concomitant medications affecting hemostasis 5, 3
• Major bleeding complications typically occur within 5 days of starting therapy 5
• Consider monitoring anti-Xa levels in high-risk patients (severe renal impairment, extremes of body weight) 3, 4

Common Pitfalls to Avoid

• Failing to adjust dose in patients with renal impairment, which can lead to accumulation and serious bleeding complications 5, 4
• Not considering age-based dosing adjustments for patients ≥75 years 1
• Switching between enoxaparin and other anticoagulants without appropriate transition protocols 1, 6
• Overlooking the need for dose adjustment when transitioning between different clinical scenarios (e.g., initial therapy to PCI support) 1