How many days should Clexane (enoxaparin) be given prophylactically for Deep Vein Thrombosis (DVT) prophylaxis in patients with cellulitis?

Duration of Enoxaparin (Clexane) for DVT Prophylaxis in Cellulitis

For patients hospitalized with cellulitis requiring DVT prophylaxis, enoxaparin should be continued for 6-21 days or until full mobility is restored or hospital discharge, whichever comes first. 1

Evidence-Based Duration Guidelines

The American College of Chest Physicians guidelines specifically address acutely ill medical patients with acute infectious conditions (which includes cellulitis) who are immobilized with additional VTE risk factors. 1 Based on moderate-quality evidence from multiple randomized controlled trials:

• Standard duration ranges from 6-21 days during hospitalization 1
• Continue until full mobility is restored or hospital discharge, whichever occurs first 1
• Minimum duration of 7-10 days is recommended for most hospitalized medical patients 1, 2, 3

Standard Dosing Regimen

• Enoxaparin 40 mg subcutaneously once daily is the recommended prophylactic dose 1, 2, 3
• This dosing has proven efficacy in reducing symptomatic DVT and fatal PE in acutely ill, hospitalized, immobilized medical patients 1

Special Considerations for Cellulitis Patients

Risk Assessment

The actual incidence of DVT in cellulitis patients is relatively low. Research shows:

• Overall DVT incidence is 2.72% (95% CI: 1.71-3.75%) when systematically investigated 4
• Only 0.68% (95% CI: 0.27-1.07%) when not systematically screened 4

However, prophylaxis is still indicated for high-risk patients with cellulitis who have additional VTE risk factors including: 1

• Age ≥40 years
• Active cancer
• Previous VTE
• Severe immobilization
• Obesity (BMI ≥40 kg/m²)

Dose Adjustments for Special Populations

For obese patients (BMI ≥40 kg/m²):

• Consider 40 mg subcutaneously every 12 hours or weight-based dosing of 0.5 mg/kg every 12 hours 2, 3

For severe renal impairment (CrCl <30 mL/min):

• Reduce dose to 30 mg subcutaneously once daily 2, 3, 5

Extended Post-Discharge Prophylaxis

For selected high-risk patients with cellulitis, consider extended prophylaxis:

• Duration of 14-30 days post-discharge may be appropriate 1
• This applies particularly to patients with multiple VTE risk factors, elevated D-dimer (>2 times upper limit of normal), or IMPROVE VTE score ≥4 1
• Use either LMWH or a DOAC for extended prophylaxis 1

Common Pitfalls to Avoid

• Do not routinely give prophylaxis to low-risk cellulitis patients without additional VTE risk factors, as the baseline DVT incidence is very low 4
• Do not discontinue prophylaxis prematurely before mobility is restored, even if clinical improvement of cellulitis occurs 1
• Do not use standard dosing in severe renal impairment without dose reduction, as this increases bleeding risk 2, 3
• Do not forget to assess bleeding risk before initiating prophylaxis, particularly in patients with active gastroduodenal ulcer, recent bleeding, or platelet count <50 × 10⁹/L 1