What is the recommended dosing of Lovenox (enoxaparin) for the treatment of Deep Vein Thrombosis (DVT)?

Enoxaparin Dosing for DVT Treatment

For treatment of acute DVT in adults, administer enoxaparin 1 mg/kg subcutaneously every 12 hours or 1.5 mg/kg subcutaneously once daily. 1, 2

Standard Therapeutic Dosing Regimens

The two FDA-approved regimens for DVT treatment are equally effective:

• 1 mg/kg subcutaneously every 12 hours (preferred regimen) 1, 2
• 1.5 mg/kg subcutaneously once daily (alternative regimen) 1, 2

Both regimens have demonstrated equivalent efficacy to dose-adjusted unfractionated heparin for symptomatic VTE recurrence and major hemorrhage. 1 The twice-daily regimen may be more efficacious in certain populations, though once-daily dosing offers advantages including improved compliance, reduced healthcare worker exposure, and potentially lower treatment costs. 1

Critical Dose Adjustments

Obesity (BMI ≥40 kg/m²)

• Reduce to 0.8 mg/kg subcutaneously every 12 hours 1, 2
• Standard fixed dosing may be inadequate in obese patients, while excessive in very low-weight patients. 1

Severe Renal Impairment (CrCl <30 mL/min)

• Dose reduction is required due to 2-3 fold increased bleeding risk 1, 2
• Enoxaparin clearance is reduced by 31% in moderate renal impairment and 44% in severe renal impairment 1
• Always check creatinine clearance before initiating therapy, as this determines dosing more than any other factor 1

Cancer Patients

• Initial treatment: 1 mg/kg subcutaneously every 12 hours for patients with BMI <40 kg/m² 1, 2
• Extended treatment duration of at least 3-6 months is recommended 1
• Consider dose reduction after the first month for long-term therapy 1

Monitoring Requirements

Baseline Testing

• CBC, renal and hepatic function panel, aPTT, and PT/INR 1

Follow-up Monitoring

• Hemoglobin, hematocrit, and platelet count every 2-3 days for the first 14 days, then every 2 weeks thereafter or as clinically indicated 1
• Platelet monitoring from day 4 to day 14 is essential to screen for heparin-induced thrombocytopenia 1

Anti-Xa Level Monitoring (When Indicated)

• Not routinely necessary for most patients 1
• Indicated for: pregnant patients on therapeutic doses, severe renal impairment on prolonged therapy 1
• Target peak anti-Xa levels: 0.6-1.0 IU/mL for twice-daily dosing or 1.0-1.5 IU/mL for once-daily dosing 1
• Measure 4-6 hours after dosing, after 3-4 doses have been administered 1

Treatment Duration

• Initial treatment typically lasts 5-10 days 1
• Cancer patients require extended treatment for at least 3-6 months 1
• Transition to oral anticoagulation can occur once therapeutic anticoagulation is achieved 1

Common Pitfalls to Avoid

• Never switch between enoxaparin and unfractionated heparin due to increased bleeding risk 1
• Failure to adjust dose in renal impairment leads to drug accumulation and increased bleeding risk 1
• Not adjusting for obesity (BMI ≥40 kg/m²) results in inadequate anticoagulation 1, 2
• Elevated liver enzymes alone do not require dose adjustment, as enoxaparin is primarily eliminated renally, not hepatically 1
• Use cautiously with other antiplatelet or anticoagulant medications due to increased bleeding risk 1

Pediatric Dosing (If Applicable)

For children >5 years: 1 mg/kg subcutaneously every 12 hours, with dose titration to achieve peak anti-Xa level of 0.5-1.0 IU/mL 3