From the Guidelines
Enoxaparin (low molecular weight heparin) subcutaneously twice daily can help prevent new thrombus formation and is used in the treatment of existing pulmonary embolism.
Enoxaparin Dosage and Administration
- The recommended dose of enoxaparin is 1 mg/kg administered subcutaneously twice daily 1.
- Enoxaparin can be used for the initial treatment of established venous thromboembolism (VTE) in patients with cancer when creatinine clearance is ≥30 mL/min (grade 1A) 1.
Prevention of New Thrombus Formation
- Low molecular weight heparin (LMWH), such as enoxaparin, is effective in preventing recurrent deep vein thrombosis (DVT) and pulmonary embolism (PE) 1.
- LMWH has been shown to reduce mortality and the risk of major bleeding during initial therapy compared to unfractionated heparin 1.
Dissolution of Existing Pulmonary Embolism
- While enoxaparin is used in the treatment of existing pulmonary embolism, the evidence suggests that it is at least as effective as unfractionated heparin in preventing recurrent PE, but its role in dissolving existing clots is not explicitly stated 1.
- Thrombolytic therapy may be considered on a case-by-case basis for patients with pulmonary embolism, especially those with hypotension, but it is not a first-line treatment and carries a high risk of bleeding 1.
From the Research
Efficacy of Enoxaparin in Dissolving Existing Pulmonary Embolism
- Enoxaparin, a low molecular weight heparin, has been shown to be as effective as unfractionated heparin in treating patients with acute pulmonary thromboembolism 2.
- A study comparing enoxaparin with unfractionated heparin found that there was no significant difference in the incidence of major bleeding, recurrent venous thromboembolism, and death between the two treatment groups 2.
- Another study found that enoxaparin was effective in preventing venous thromboembolism in medical patients, with a significant reduction in the incidence of deep vein thrombosis and pulmonary embolism compared to placebo 3.
Prevention of New Thrombus Formation
- Enoxaparin has been shown to be effective in preventing new thrombus formation in patients with deep vein thrombosis with or without pulmonary embolism 4.
- A meta-analysis of individual patient data from randomized controlled trials found that enoxaparin was non-inferior to unfractionated heparin in preventing venous thromboembolism at 3 months, with no increase in major bleeding or mortality 4.
- The efficacy and safety of enoxaparin in preventing new thrombus formation is not modified by the presence of symptomatic pulmonary embolism 4.
Safety and Adverse Effects
- Enoxaparin has been shown to be safe and effective in treating patients with pulmonary embolism, with a low risk of major bleeding and mortality 2, 5.
- However, rare adverse effects such as reactive thrombocytosis have been reported, highlighting the need for close monitoring of blood counts in patients receiving enoxaparin 6.