Enoxaparin

Creatinine Clearance (CrCl) >30 ml/min
1. Normal Dosing (BMI 18.5 to 40 kg/m2 or weight <100 kg)
  1. Enoxaparin (Lovenox) 40 mg SQ daily for medical inpatients or abdominal surgery
  2. Enoxaparin (Lovenox) 30 mg SQ every 12 hours if s/p knee or hip replacement
2. Morbid Obesity (BMI >40 kg/m2 or weight >100 kg)
  1. BMI 40 to 49 kg/m2: Enoxaparin 40 mg SQ twice daily
  2. BMI >=50 kg/m2: Enoxaparin 60 mg SQ twice daily
3. Low Body Weight (BMI <18.5 kg/m2 or weight <50 kg)
  1. Enoxaparin 30-40 mg SQ once daily
Creatinine Clearance (CrCl) 15-30 ml/min (or weight <40 kg)
1. Enoxaparin (Lovenox) 30 mg SQ daily
Creatinine Clearance (CrCl) <15 ml/min
1. Enoxaparin (Lovenox) is contraindicated
2. Use Unfractionated Heparin 5000 units SQ every 8-12 hours

Creatinine Clearance (CrCl) >30 ml/min
1. Normal Dosing (BMI <40 kg/m2 or weight <100 kg)
  1. Enoxaparin (Lovenox) 1 mg/kg SQ every 12 hours OR
  2. Enoxaparin 1.5 mg/kg SQ every 24 hours for inpatients with acute VTE (DVT, PE)
2. Morbid Obesity (BMI >40 kg/m2 or weight >100 kg)
  1. Enoxaparin (Lovenox) 0.75 to 0.85 mg/kg SQ every 12 hours
Creatinine Clearance (CrCl) 15-30 ml/min (or weight <40 kg)
1. Unfractionated Heparin is preferred
2. As an alternative, Enoxaparin (Lovenox) 1 mg/kg SQ once daily for up to 7 days
Creatinine Clearance (CrCl) <15 ml/min
1. Enoxaparin (Lovenox) is contraindicated
2. Use Unfractionated Heparin 5000 units SQ every 8-12 hours

Use in pregnancy when benefit outweighs the risk
Considered safe in Lactation
Factor Xa levels are not accurate for monitoring LMWH SQ Injection thereapeutic range

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