What is the recommended dose of Clexane (enoxaparin) for anticoagulation?

Enoxaparin (Clexane) Dosing for Anticoagulation

The recommended dose of enoxaparin depends on the clinical indication: for treatment of venous thromboembolism (VTE), use 1 mg/kg subcutaneously every 12 hours; for acute coronary syndrome, use 1 mg/kg subcutaneously every 12 hours; for thromboprophylaxis, use 40 mg subcutaneously once daily. 1, 2

Treatment Dosing (Therapeutic Anticoagulation)

Standard VTE Treatment

• Administer 1 mg/kg subcutaneously every 12 hours for treatment of deep vein thrombosis or pulmonary embolism 1, 3
• An alternative regimen of 1.5 mg/kg once daily has equivalent efficacy and safety, though the twice-daily regimen is more commonly used 3
• Continue for the duration of hospitalization or until definitive intervention is performed 1, 2

Acute Coronary Syndrome (ACS)

• Standard dose: 1 mg/kg subcutaneously every 12 hours 1, 2
• An optional 30 mg intravenous loading dose may be given in selected patients, though this is not mandatory 1, 2
• For patients <75 years receiving fibrinolytic therapy: 30 mg IV bolus, followed in 15 minutes by 1 mg/kg subcutaneously every 12 hours (maximum 100 mg for first 2 doses) 2
• For patients ≥75 years receiving fibrinolytic therapy: no bolus, give 0.75 mg/kg subcutaneously every 12 hours (maximum 75 mg for first 2 doses) 2

Cancer-Associated VTE

• Dalteparin is the preferred LMWH (200 units/kg daily for 30 days, then 150 units/kg daily) with the strongest evidence in cancer patients 1
• If using enoxaparin: 1 mg/kg subcutaneously every 12 hours, though long-term use at this dose has not been extensively tested in cancer patients 1

Prophylactic Dosing

Standard Thromboprophylaxis

• 40 mg subcutaneously once daily for general VTE prophylaxis 1, 4
• Alternative: 30 mg subcutaneously twice daily (used in some protocols) 1

Obstetric/Postpartum Prophylaxis

• 40 mg subcutaneously once daily is the standard prophylactic dose 1
• For class III obesity (BMI ≥40 kg/m²): consider intermediate dosing of 40 mg subcutaneously every 12 hours 1
• Alternative for morbidly obese women: weight-based dosing of 0.5 mg/kg subcutaneously every 12 hours may achieve more consistent anti-Xa levels 1

Critical Dosing Adjustments

Renal Impairment

• For creatinine clearance <30 mL/min: reduce to 1 mg/kg subcutaneously once daily (instead of every 12 hours) 1, 2, 5
• This dose reduction applies to both therapeutic and prophylactic indications 1, 2
• Studies demonstrate this reduced dose is safe and does not result in excessive anticoagulation in severe renal failure 5

Obesity

• For BMI ≥40 kg/m²: consider 40 mg subcutaneously every 12 hours for prophylaxis rather than fixed daily dosing 1
• Weight-based prophylactic dosing of 0.5 mg/kg every 12 hours may be superior to fixed dosing in morbidly obese patients 1
• Therapeutic dosing remains 1 mg/kg every 12 hours regardless of weight 6

PCI-Specific Dosing Adjustments

Patients Already on Enoxaparin

• If last subcutaneous dose was 8-12 hours prior OR only 1 dose given: administer 0.3 mg/kg IV at time of PCI 1, 2
• If last dose was within 8 hours: no additional enoxaparin needed 1, 2
• If last dose was >12 hours prior: treat as de novo anticoagulation 1

Patients Not Previously Anticoagulated

• Administer 0.5-0.75 mg/kg IV bolus at time of PCI 1, 2

Critical Safety Warnings

Avoid "Stacking" with UFH

• Never administer unfractionated heparin to patients already receiving therapeutic enoxaparin 1, 7
• This combination causes excessive anticoagulation that is not detected by activated clotting time monitoring 7
• The SYNERGY trial demonstrated increased bleeding when patients on enoxaparin received additional UFH at PCI 1

Timing with Neuraxial Anesthesia

• Prophylactic doses (40 mg daily): may start 4 hours after catheter removal but not earlier than 12 hours after block placement 1
• Intermediate/therapeutic doses: may start 4 hours after catheter removal but not earlier than 24 hours after block placement 1

Duration Considerations

• Continue for duration of hospitalization or until PCI/intervention is performed 1, 2
• Premature discontinuation increases risk of rebound thrombin activity and reinfarction, with greatest risk in first 4-8 hours 2
• For cancer-associated VTE, extended therapy for 2-6 months is recommended 1