Enoxaparin

💊 What is Enoxaparin used for?

• •Preventing deep vein thrombosis (a blood clot in a deep vein) after abdominal surgery, hip replacement surgery, or knee replacement surgery
• •Preventing deep vein thrombosis in medical patients with severely restricted mobility during acute illness
• •Treating acute deep vein thrombosis with or without pulmonary embolism (a clot in the lungs), in the hospital, when given together with warfarin
• •Treating acute deep vein thrombosis without pulmonary embolism in an outpatient setting, when given together with warfarin
• •Preventing ischemic complications (such as blocked blood flow to the heart) of unstable angina and non-Q-wave heart attack, when given with aspirin
• •Treating acute ST-segment elevation heart attack (STEMI) that is managed with medicine or with percutaneous coronary intervention (PCI), when given with aspirin

How it works

The label describes enoxaparin as a low molecular weight heparin that produces an anticoagulant (blood-thinning) effect. This helps lower the chance of new clots forming or existing clots growing.

How it is usually taken

• •The label says enoxaparin is injected under the skin (subcutaneous) and that it should not be injected into muscle. The Instructions for Use describe an injection into the stomach area (abdomen), at least 2 inches from the belly button, and switching between the left and right sides each time. The label says not to inject into skin that has bruises or scars, not to rub the site after injecting, and not to pull back on the plunger. The label also lists an intravenous (IV) route. The prescriber decides the dose and how often it is given, and the dose may be based on body weight. Follow the instructions from your prescriber or pharmacist. The label says each prefilled syringe is for one-time use only.

Comes as

• •Injection, 100 mg/mL concentration: single-dose prefilled syringes of 30 mg/0.3 mL and 40 mg/0.4 mL
• •Injection, 100 mg/mL concentration: single-dose graduated prefilled syringes of 60 mg/0.6 mL, 80 mg/0.8 mL, and 100 mg/1 mL
• •Injection, 100 mg/mL concentration: multiple-dose vial of 300 mg/3 mL
• •Injection, 150 mg/mL concentration: single-dose graduated prefilled syringes of 120 mg/0.8 mL and 150 mg/1 mL

⚠️ Enoxaparin side effects

🛑 Who should not take Enoxaparin, and who should be careful

The label says not to take it if

• 🚨You have active major bleeding
• 🚨You have a history of heparin-induced thrombocytopenia (HIT) within the past 100 days, or you have circulating antibodies for it
• 🚨You are allergic to enoxaparin
• 🚨You are allergic to heparin or pork products
• 🚨You are allergic to benzyl alcohol (this applies only to the multiple-dose vial)

Tell your doctor before taking it if

• •Your provider should check you for a bleeding disorder before starting enoxaparin, unless treatment is urgently needed.
• •Tell your doctors and dentists that you take enoxaparin before any surgery is scheduled and before you start any new medicine.
• •Tell your doctors and dentists about all medicines you take, including those bought without a prescription, such as aspirin or other NSAIDs.
• •The label says you may bruise or bleed more easily, and it may take longer than usual to stop bleeding.
• •The label says the multiple-dose vials contain benzyl alcohol, and that its risks in newborns, infants, and pregnant women should be discussed.
• •The label says enoxaparin should be used with extreme caution in conditions with higher bleeding risk, such as bacterial endocarditis, bleeding disorders, and active ulcerative or angiodysplastic gastrointestinal lesions.
• •The label says pregnant women with mechanical prosthetic heart valves may have a higher risk of clots and should be monitored more often.
• •Tell your provider if you have had a spinal puncture or spinal anesthesia, or if you are scheduled for one.

🔀 Enoxaparin with other medicines, food and alcohol

The label says to discuss these with your doctor or pharmacist

• •The label says drugs that increase bleeding risk should be stopped before enoxaparin is started when possible. These include other anticoagulants, aspirin and other salicylates, platelet inhibitors, NSAIDs (including ketorolac), dipyridamole, and sulfinpyrazone.
• •If these drugs must be used together with enoxaparin, the label says close clinical and lab monitoring is needed.
• •For deep vein thrombosis treatment, the label says enoxaparin is given together with warfarin.
• •Enoxaparin is also used with aspirin for certain heart conditions, as described in the indications.

Alcohol and food

The label does not say.

🤰 Enoxaparin in pregnancy and breastfeeding

Pregnancy

The label says placental transfer of enoxaparin was seen in animal studies. A retrospective human cohort study of 693 live births suggests enoxaparin does not increase the risk of major developmental abnormalities. Pregnancy alone raises the risk of blood clots, and the label says pregnant women with mechanical prosthetic heart valves may be at even higher risk of clots. Discuss pregnancy plans and risks with your provider.

Breastfeeding

The label does not say.

🗓️ Storage, missed doses and taking too much

Storage

The label says to store enoxaparin prefilled syringes at 25°C (77°F), with short excursions allowed between 15°C and 30°C (59°F and 86°F). Keep it in the original carton or packaging until ready to use. Do not store multiple-dose vials for more than 28 days after the first use. Keep it out of the reach of children. The label says not to use the syringe if the liquid is discolored or cloudy, or if it contains visible flakes or particles.

If a dose is missed

The label does not say.

If too much is taken

The label says accidental overdose may lead to bleeding complications. A healthcare professional may give protamine sulfate (1% solution) by slow intravenous injection to largely neutralize enoxaparin. The label gives the protamine dosing rules for use by healthcare professionals. If you think someone has taken too much, get emergency medical help right away.

🗒️ Questions to ask about Enoxaparin

• Why am I being prescribed enoxaparin instead of another blood thinner?
• How will I know if I am bleeding too much, and what should I do?
• What spinal or epidural warning signs should I watch for, and who should I call right away?
• Do I need to stop any of my current medicines, such as aspirin or NSAIDs, before starting enoxaparin?
• Will I need blood tests to check my platelet count while I take this medicine?
• What should I tell my dentist or surgeon before a procedure?
• How should I inject the medicine and dispose of the used syringe safely?

❓ Enoxaparin: frequently asked questions