What should a patient on Enoxaparin (Low Molecular Weight Heparin) do if they experience dizziness and miss a dose?

Management of Dizziness and Missed Enoxaparin Dose

If you experience dizziness while on enoxaparin and miss a dose, take the missed dose as soon as you remember on the same day, but never double up doses—missing even a single dose nearly doubles your risk of blood clots. 1

Immediate Actions for Missed Dose

• Take the missed dose immediately if you remember within the same dosing day, but skip it entirely if it's almost time for your next scheduled dose 2
• Never take two doses together to make up for a missed dose, as this significantly increases bleeding risk 2
• Resume your regular dosing schedule with the next dose at the usual time 2

Understanding the Dizziness

Dizziness is not a typical side effect of enoxaparin itself, so this symptom warrants immediate medical evaluation for several critical concerns:

Potential Serious Causes Requiring Emergency Evaluation

• Internal bleeding: Dizziness may indicate significant blood loss from gastrointestinal, intracranial, or other occult bleeding—the most dangerous complication of enoxaparin 2
• Severe anemia: Bleeding-related anemia is a common adverse event (reported in up to 17.4% of patients on enoxaparin) and can manifest as dizziness 3
• Pulmonary embolism: Paradoxically, if you've missed doses, dizziness could indicate a blood clot that has traveled to your lungs 1
• Hypotension from bleeding: Check for other signs including weakness, pale skin, rapid heartbeat, or confusion 2

When to Seek Emergency Care

• Go to the emergency department immediately if dizziness is accompanied by: severe headache, vision changes, chest pain, shortness of breath, abdominal pain, black/tarry stools, blood in urine, or unusual bruising 2
• Contact your physician urgently if dizziness persists or worsens, even without other symptoms 3

Critical Importance of Dose Adherence

Missing enoxaparin doses dramatically increases thrombotic risk:

• Patients who miss at least one prophylactic dose have 1.92 times higher odds of developing venous thromboembolism (95% CI 0.997-3.7) 1
• The risk increases significantly with each consecutively missed dose 1
• In trauma patients, 34.8% of those who developed blood clots had missed at least one dose, compared to only 21.7% of those without clots 1

Common Pitfalls to Avoid

• Do not stop enoxaparin abruptly without physician guidance, as this creates a rebound hypercoagulable state 1
• Do not switch between enoxaparin and other anticoagulants (like unfractionated heparin) on your own, as this increases bleeding risk 2
• Do not assume dizziness is benign—it requires medical evaluation to rule out bleeding complications 2, 3
• Do not take aspirin or other antiplatelet medications without explicit physician approval, as combining these with enoxaparin substantially increases bleeding risk 2

Monitoring Recommendations

• Check for signs of bleeding: Look for unusual bruising, petechiae (small red spots on skin), bleeding gums, nosebleeds, or prolonged bleeding from cuts 3
• Monitor injection sites: Hematomas at injection sites occur commonly but should not be expanding or increasingly painful 3
• Track your doses carefully: Use a medication diary or phone app to prevent future missed doses, as even single omissions carry significant risk 1

Special Considerations Based on Your Clinical Context

If You Have Renal Impairment

• Enoxaparin accumulates in patients with creatinine clearance <30 mL/min, increasing bleeding risk by 2.25-fold 4
• Dizziness may indicate drug accumulation and impending bleeding complications 4
• Your dose may need adjustment to once-daily instead of twice-daily 4, 5

If You Are Elderly (≥75 years)

• Elderly patients have higher bleeding risk even at standard doses 2, 4
• Dizziness warrants more aggressive evaluation in this population 4

If You Weigh <55 kg

• Low body weight increases bleeding risk independently 4
• Standard dosing may be excessive for your weight 4