From the Guidelines
Lovenox (enoxaparin) can be used with caution in patients with thrombocytopenia, but the dose and management strategy depend on the severity of thrombocytopenia and the risk of thrombus progression.
Guidance for Use
- For patients with a platelet count of ≥ 50 x 10^9 L^-1, full therapeutic anticoagulation with Lovenox (enoxaparin) can be given without platelet transfusion 1.
- For patients with severe thrombocytopenia (< 50 x 10^9 L^-1) and a higher risk of thrombus progression, full-dose anticoagulation with Lovenox (enoxaparin) can be used with platelet transfusion support to maintain a platelet count of ≥ 40–50 x 10^9 L^-1 1.
- For patients with severe thrombocytopenia (< 50 x 10^9 L^-1) and a lower risk of thrombus progression, the dose of Lovenox (enoxaparin) can be reduced to 50% of the therapeutic dose or a prophylactic dose can be used in patients with a platelet count of 25–50 x 10^9 L^-1 1.
Important Considerations
- Anticoagulation should be temporarily discontinued in patients with a platelet count < 25 x 10^9 L^-1 1.
- Full-dose Lovenox (enoxaparin) can be resumed when the platelet count is > 50 x 10^9 L^-1 without transfusion support, in the absence of other contraindications 1.
From the Research
Enoxaparin Use in Thrombocytopenia
- Enoxaparin can be used safely in patients with severe thrombocytopenia due to intensive chemotherapy regimens, as long as the dosages are reduced 2.
- A study found that reduced dosages of low molecular weight heparins, such as enoxaparin, may be used relatively safely during transient severe thrombocytopenia 2.
- However, enoxaparin can also cause thrombocytosis, a rare adverse reaction, as reported in a case study 3.
Safety and Efficacy of Enoxaparin in Thrombocytopenia
- Enoxaparin has been shown to be efficacious and safe in the management of deep venous thrombosis with or without pulmonary embolism in patients affected by acute leukemia, even with severe thrombocytopenia 4.
- A quality assessment study found that enoxaparin dose reduction for thrombocytopenia in patients with cancer is safe and effective, with no recurrent VTE events or major bleeding episodes when the anticoagulant dose is reduced or held 5.
- However, another study found that thrombocytopenia was associated with an increased risk of bleeding in patients receiving enoxaparin for VTE prophylaxis 6.
Guidelines for Enoxaparin Use in Thrombocytopenia
- Guidelines for enoxaparin dose modification in patients with thrombocytopenia have been proposed, including administering full-dose enoxaparin for a platelet count >50,000/mcL, half-dose enoxaparin for a platelet count of 25,000-50,000/mcL, and holding anticoagulation for a platelet count <25,000/mcL 5.
- These guidelines have been validated in a quality assessment study, which found that they are safe and effective in reducing the risk of bleeding and recurrent VTE events 5.