Enoxaparin is a low molecular weight heparin marketed as Lovenox or Clexane. It is used to prevent and treat deep vein thrombosis or pulmonary embolism, and is given as a subcutaneous injection (by a health care provider or the patient). Its use is evolving in acute coronary syndromes (ACS).
Enoxaparin is manufactured by Sanofi-Aventis and is derived from the intestinal mucosa of pigs.
In the UK and Australia, enoxaparin is approved for six indications:
In the United States, enoxaparin is FDA approved for eight indications:
- Prophylaxis of DVT in medically ill patient,
- Total hip & knee replacement,
- Extended hip-replacement,
- Abdominal surgery.
- Treatment of DVT with or without PE inpatient and
- Treatment of DVT inpatient, with ACS, including STEMI.
Mechanism of action
Enoxaparin binds to and accelerates the activity of antithrombin III. By activating antithrombin III, enoxaparin preferentially potentiates the inhibition of coagulation factors Xa and IIa. The anticoagulant effect of enoxaparin can be directly correlated to its ability to inhibit factor Xa. Factor Xa catalyzes the conversion of prothrombin to thrombin, so enoxaparin’s inhibition of this process results in decreased thrombin and ultimately the prevention of fibrin clot formation.
- Category B: enoxaprin is safe for use in the second trimester as it does not cross the placenta and safe while breast feeding
Decreased dose recommended in renal failure or ESRD patients. For DVT prophylaxis in a patient with GFR < 30, a dose of 30mg daily is recommended. For DVT prophylaxis in a patient with GFR > 30, full dose (40mg daily) can be given. For treatment of DVT/PE, the standard recommended dose is 1.5mg/kg once daily. If the GFR < 30, the dose should be changed to 1mg/kg daily.
- Protamine, although not as effective at reversal as it is for heparin due to more activity at the Xa clotting factor (enoxaparin); as heparin has both Xa and IIa. Protamine sulfate will reverse enoxaparin by 66% per package insert.
100 mg/mL concentration
- Prefilled Syringes: 30mg/0.3mL, 40mg/0.4mL
- Graduated Prefilled Syringes: 60mg/0.6mL, 80mg/0.8mL, 100mg/1mL
- Multiple Dose Vials: 300mg/3.0mL
- Graduated Prefilled Syringes: 120mg/0.8mL, 150mg/1mL
Annual sales approx $3.1bn. Enoxaparin is no longer protected by US patent due to inequitable conduct on the filing of Patent No. 5,389,618 (Fed. Cir. 2008 No. 2007-1280 Aventis Pharma v. Amphastar and Teva)
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