Indications

Deep vein thrombosis treatment, with or without pulmonary embolism.
Unstable angina and non‑Q‑wave myocardial infarction, administered concurrently with aspirin.
Prevention of thrombus formation in extracorporeal circulation during hemodialysis.
Prophylaxis of venous thromboembolic disease in surgical patients (orthopedic or general surgery).
Prophylaxis of venous thromboembolic disease in medical patients bedridden due to acute illness (e.g., cardiac insufficiency, respiratory failure, severe infections, rheumatic diseases).

Composition

Low molecular weight heparin with high anti‑Xa activity and low anti‑IIa (antithrombin) activity.
At therapeutic doses, does not prolong bleeding time significantly.
At prophylactic doses, no major effect on activated Partial Thromboplastin Time (aPTT).
Does not influence platelet aggregation or fibrinogen binding.
Primarily metabolized in the liver.

DVT treatment: 100 anti‑Xa IU/kg SC twice daily for 10 days, or 150 anti‑Xa IU/kg SC once daily for 10 days. Continue until oral anticoagulant therapy is therapeutic.
Unstable angina / non‑Q‑wave MI: 100 anti‑Xa IU/kg SC twice daily for 2–8 days, with aspirin (100–325 mg daily).
Hemodialysis: 100 anti‑Xa IU/kg into arterial line at start of session. Adjust dose for bleeding risk (50–75 IU/kg).
Surgical prophylaxis:
- General surgery (moderate risk): 2000–4000 anti‑Xa IU SC once daily for 7–10 days. First dose 2 hours before surgery.
- Orthopedic surgery (high risk): 4000 anti‑Xa IU SC once daily for 7–10 days. First dose 12 hours before surgery. Extended prophylaxis up to 3 weeks may be beneficial.
Medical prophylaxis: 4000 anti‑Xa IU SC once daily for 6–14 days.

Inject SC into abdominal wall, alternating left/right sides, at least 5 cm away from the navel.
Do not inject into bruised or scarred areas.
Do not rub injection site after administration.
Dispose of used syringes in a sharps container.

Increased bleeding risk with: aspirin, NSAIDs (e.g., ketorolac), ticlopidine, clopidogrel, dextran, glucocorticoids, thrombolytics, other anticoagulants, GP IIb/IIIa antagonists.
Use only with strict monitoring if combination is necessary.

Hypersensitivity to enoxaparin, heparin, or LMWHs.
Active major bleeding.
Conditions with high risk of uncontrolled hemorrhage (e.g., recent hemorrhagic stroke).

Pregnancy Category C: No evidence of placental transfer, but limited controlled studies. Use only if clearly needed.
Mechanical prosthetic heart valve patients may be at higher risk of thrombosis.
Unknown if excreted in breast milk; weigh benefits of nursing vs. therapy.

Administer only by SC (prophylaxis/therapy) or IV (during dialysis). Never IM.
Use caution in patients with increased bleeding risk: impaired hemostasis, peptic ulcer history, recent ischemic stroke, uncontrolled hypertension, diabetic retinopathy, recent surgery.