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Creatinine Clearance (CrCl) >30 ml/min AND Weight 40-150 kg
- Enoxaparin (Lovenox) 40 mg SQ daily for medical inpatients or abdominal surgery
- Enoxaparin (Lovenox) 30 mg SQ every 12 hours if s/p knee or hip replacement
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Creatinine Clearance (CrCl) >30 ml/min AND Weight >150 kg (or BMI 40 of higher)
- Enoxaparin (Lovenox) 40 mg SQ twice daily
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Creatinine Clearance (CrCl) 15-30 ml/min (or weight <40 kg)
- Enoxaparin (Lovenox) 30 mg SQ daily
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Creatinine Clearance (CrCl) <15 ml/min
- Enoxaparin (Lovenox) is contraindicated
- Use unfractionated heaprin 5000 units SQ every 8-12 hours
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Creatinine Clearance (CrCl) >30 ml/min
- Enoxaparin (Lovenox) 1 mg/kg SQ every 12 hours OR
- Enoxaparin (Lovenox) 1.5 mg/kg SQ every 24 hours for inpatients with acute VTE (DVT, PE)
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Creatinine Clearance (CrCl) 15-30 ml/min (or weight <40 kg)
- Unfractionated Heparin is preferred
- As an alternative, Enoxaparin (Lovenox) 1 mg/kg SQ once daily for up to 7 days
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Creatinine Clearance (CrCl) <15 ml/min
- Enoxaparin (Lovenox) is contraindicated
- Use Unfractionated Heparin 5000 units SQ every 8-12 hours
- Use in pregnancy when benefit outweighs the risk
- Considered safe in Lactation
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