What about Enoxaparin?

From the Guidelines

Enoxaparin is approved by the FDA for the immediate treatment of VTE.

Enoxaparin Use

• Enoxaparin is used for the prevention and treatment of VTE, and has been shown to be effective in reducing the incidence of VTE in patients with cancer 1.
• The recommended dosing regimens for enoxaparin in VTE treatment are based on the results of clinical studies and panel consensus, with a fixed dosage of 1.0 mg/kg twice daily or 1.5 mg/kg once daily being equivalent to dose-adjusted UFH in terms of symptomatic VTE and major hemorrhage 1.
• Enoxaparin has been found to be a safe and effective option for the treatment of VTE in patients with cancer, with a lower incidence of VTE compared to oral vitamin K antagonists 1.

Special Populations

• Specific dosing recommendations for patients with severe renal insufficiency (creatinine clearance <30 mL/min) are available only for enoxaparin, with a recommended dose of 30 mg of subcutaneous enoxaparin daily for VTE prophylaxis and 1 mg/kg subcutaneously every 24 hours for VTE treatment 1.
• Enoxaparin has been shown to be associated with a 2- to 3-fold increased risk of bleeding when administered in standard, unadjusted therapeutic doses to patients with severe renal insufficiency, and dose reductions are recommended for patients with creatinine clearance <50 mL/min 1.

Comparison to Other LMWHs

• Dalteparin has been found to be more effective than enoxaparin in preventing recurrent VTE in patients with cancer, with a lower incidence of VTE and no increase in the risk of bleeding 1.
• Tinzaparin has been shown to be equivalent to dalteparin in efficacy and safety in the treatment of DVT and PE in patients with cancer, but has not been specifically studied in patients with renal insufficiency 1.

From the FDA Drug Label

PACKAGE LABEL.PRINCIPAL DISPLAY PANEL NDC 11797-757-06 Enoxaparin Sodium Injection USP 30 mg/0.3 mL SINGLE-DOSE SYRINGES WITH AUTOMATIC SAFETY DEVICE FOR SUBCUTANEOUS INJECTION Ten 0.3 mL Syringes NDC 11797-758-06 Enoxaparin Sodium Injection USP 40 mg/0.4 mL SINGLE-DOSE SYRINGES WITH AUTOMATIC SAFETY DEVICE FOR SUBCUTANEOUS INJECTION Ten 0. 4 mL Syringes NDC 11797-759-06 Enoxaparin Sodium Injection USP 60 mg/0.6 mL SINGLE-DOSE SYRINGES WITH AUTOMATIC SAFETY DEVICE FOR SUBCUTANEOUS INJECTION Ten 0.6 mL Syringes NDC 11797-760-06 Enoxaparin Sodium Injection USP 80 mg/0.8 mL SINGLE-DOSE SYRINGES WITH AUTOMATIC SAFETY DEVICE FOR SUBCUTANEOUS INJECTION Ten 0. 8 mL Syringes NDC 11797-761-06 Enoxaparin Sodium Injection USP 100 mg/1 mL SINGLE-DOSE SYRINGES WITH AUTOMATIC SAFETY DEVICE FOR SUBCUTANEOUS INJECTION Ten 1 mL Syringes NDC 11797-762-06 Enoxaparin Sodium Injection USP 120 mg/0.8 mL SINGLE-DOSE SYRINGES WITH AUTOMATIC SAFETY DEVICE FOR SUBCUTANEOUS INJECTION Ten 0. 8 mL Syringes NDC 11797-763-06 Enoxaparin Sodium Injection USP 150 mg/1 mL SINGLE-DOSE SYRINGES WITH AUTOMATIC SAFETY DEVICE FOR SUBCUTANEOUS INJECTION Ten 1 mL Syringes

The provided text does not contain information about the indications, dosage, administration, or contraindications of Enoxaparin.

• The available doses of Enoxaparin are listed as:
  • 30 mg/0.3 mL
  • 40 mg/0.4 mL
  • 60 mg/0.6 mL
  • 80 mg/0.8 mL
  • 100 mg/1 mL
  • 120 mg/0.8 mL
  • 150 mg/1 mL
• The route of administration is subcutaneous injection 2. The FDA drug label does not provide sufficient information to answer the question about Enoxaparin.

From the Research

Enoxaparin Overview

• Enoxaparin is a low molecular weight heparin (LMWH) with several advantages over unfractionated heparin (UFH), including a longer plasma half-life, higher bioavailability, and a more convenient route of administration 3, 4.
• It has been shown to be effective in the management of venous and arterial thromboembolism, with a wide range of doses and indications approved in different countries 3, 5.

Clinical Applications

• Enoxaparin has been demonstrated to be effective in preventing venous thromboembolic events, reducing the costs associated with investigating symptoms of deep vein thrombosis (DVT), acute treatment, and hospitalization 3.
• It has also been shown to be effective in the treatment of unstable angina and non-ST-segment elevation myocardial infarction, without increasing major bleeding 3, 6.
• Enoxaparin has been used in various clinical situations, including general surgery, cancer, orthopedic, and vascular surgery, with efficacy similar to or higher than UFH 6.

Pharmacodynamic and Pharmacokinetic Properties

• Enoxaparin has a higher ratio of anti-Xa to anti-IIa activity, more consistent release of tissue factor pathway inhibitor, weaker interactions with platelets, and less inhibition of bone formation compared to UFH 7.
• It has a higher and more consistent bioavailability after subcutaneous administration, a longer plasma half-life, and is less strongly bound to plasma proteins compared to UFH 7.

Safety and Efficacy

• Adverse events with enoxaparin are infrequent, with the most common events being minor bleeding complications 3.
• Enoxaparin has been shown to be a safe and effective alternative to UFH in various clinical situations, with similar efficacy and safety in the prevention and treatment of venous thromboembolism 5, 6.