Enoxaparin Dosing for a 62 kg Patient
For a 62 kg patient, enoxaparin should be dosed at 62 mg subcutaneously every 12 hours for therapeutic anticoagulation (VTE treatment or acute coronary syndrome), or 40 mg subcutaneously once daily for prophylaxis. 1
Therapeutic Dosing (Treatment of VTE or ACS)
The standard therapeutic dose is 1 mg/kg subcutaneously every 12 hours, which equals 62 mg every 12 hours for this patient. 1, 2
- For acute coronary syndromes, consider an initial 30 mg IV bolus followed by the weight-based subcutaneous dosing (though the first two subcutaneous doses should not exceed 100 mg). 2, 3
- An alternative once-daily regimen of 1.5 mg/kg (93 mg) once daily is also effective for VTE treatment, though twice-daily dosing is more commonly used. 1, 4
Critical Adjustments to Consider
Renal function must be assessed before dosing. If creatinine clearance is <30 mL/min, reduce to 1 mg/kg (62 mg) once daily instead of twice daily to prevent accumulation and bleeding. 1, 2, 5
Age matters significantly. If the patient is ≥75 years old and receiving fibrinolytic therapy for STEMI, avoid enoxaparin entirely due to increased bleeding risk. 1 For elderly patients ≥75 years with ACS not receiving fibrinolytics, reduce the dose to 0.75 mg/kg every 12 hours and omit the IV bolus. 2, 3
Prophylactic Dosing (VTE Prevention)
The standard prophylactic dose is 40 mg subcutaneously once daily. 1, 6
- This fixed dose is appropriate for patients weighing >55 kg. 6
- At 62 kg, this patient falls comfortably within the standard prophylactic dosing range without need for adjustment. 7, 6
Monitoring Considerations
Routine anti-Xa monitoring is not required for standard dosing in a 62 kg patient with normal renal function. 1
- Anti-Xa monitoring should be considered if severe renal impairment develops, pregnancy occurs, or if there are concerns about therapeutic response. 1, 2
- Target therapeutic anti-Xa levels are 0.6-1.0 IU/mL when measured 4 hours after the third or fourth dose. 2
- Platelet count monitoring is necessary to detect heparin-induced thrombocytopenia. 1
Common Pitfalls to Avoid
Do not use total body weight for dosing in morbidly obese patients without considering dose capping. For this 62 kg patient, this is not a concern, but be aware that patients >100 kg may require dose adjustments. 7, 2
Never switch between enoxaparin and unfractionated heparin during active treatment. This increases bleeding risk significantly. 2
Do not forget to assess renal function before each dosing decision. Enoxaparin clearance is primarily renal, and even mild-to-moderate renal impairment (creatinine 133-177 μmol/L) affects drug accumulation. 5
Avoid giving the standard 40 mg prophylactic dose if the patient weighs <50 kg. Though this patient weighs 62 kg and is safe for standard dosing, be vigilant about weight thresholds. 1, 6