Alternate Name(s):
Lovenox
Classification:
Antithrombotic-low molecular weight heparin
Original Date:
August 2003
Revised Date:
April 2017
Indications:
- Prophylaxis and treatment of thromboembolic disorders
Administration:
- SC
Dosage:
< 2 months:
- Treatment dose: 3.5 mg/kg/day divided Q12H
- Prophylactic dose: 1.5 mg/kg/day daily or divided Q12H
> 2 months and PNA > 38 weeks:
- Treatment dose: 2 mg/kg/day divided Q12H
- Prophylactic dose: 1 mg/kg/day daily or divided Q12H
Side Effects:
- CNS: fever
- CVS: edema, hypotension
- Hematologic: bruising, hematemesis, nosebleed, melena, coffee ground emesis, hematuria, hemoptysis, thrombocytopenia (incidence or heparin-induced thrombocytopenia is less than with heparin therapy)
- Local: irritation, pain, hematoma, local erythema
Parameters to Monitor:
- CBC, PT, and APTT prior to initiation of enoxaparin
- Platelets, antifactor Xa level (if initial measurement is therapeutic, monitor once weekly)
- Serum creatinine (elimination may be delayed in renal impairment-monitor antifactor Xa levels closely)
- Therapeutic antifactor Xa level (measure 4 - 6 hours after SC administration)
- Treatment dose: 0.5 - 1 unit/mL
- Prophylactic dose: 0.2 - 0.4 units/mL
Reconstitution and Stability:
CHEO:
- 20 mg/mL Enoxaparin syringe prepared by pharmacy (doses < 10 mg)
- 100 mg/mL Enoxaparin syringe prepared by pharmacy (doses > 10 mg)
TOH:
- Enoxaparin 30 mg/0.3 mL - prefilled syringe
- Take 0.3 mL (30 mg) add to 1.2 mL of 0.9% NaCl
- Final concentration: 20 mg/mL
Compatibility:
N/A
Notes:
- Antidote:
- Discontinue enoxaparin
- 1 mg of protamine per 100 units (1 mg) of enoxaparin given in last dose (administer protamine IV over 10 minutes)
- Hold enoxaparin for 2 doses prior to invasive procedures (eg. Spinal puncture)
References:
- Monagle P, Chan AK, Goldenberg NA, Ichord RN, Journeycake JM, Nowak-Gottl U, Vesely SK. Antithrombotic therapy in neonates and children: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest: 2012 Feb; 141 (2 Suppl): e737S-801S.
- Malowany, J.I., Knoppert, D.C., Chan, A.K.C., Pepelassis, D., and Lee, D.S.C. (2007). Enoxaparin Use in the Neonatal Intensive Care Unit: Experience Over 8 Years. Pharmacotherapy, 27: 1263-1271.
-Taketomo CK, Hodding JH, Kraus DM. Pediatric Dosage Handbook 22nd Editions. Hudson: Lexi-Comp Inc.; 2015