Enoxaparin Sodium Injection Heparin And Low Molecular Weight
Heparin Pre-filled injection
Product : Enoxaparin Sodium Injection Pre-filled Syringe
Specification : PFS, 0.2ml/20 mg, 0.4ml/40 mg, 0.6ml/60 mg &
Standard : In - house, BP
Packing : 2’s/box
Enoxaparin is a low molecular weight heparin. Enoxaparin is used to
prevent and treat deep vein thrombosis or pulmonary embolism, and
is given as a subcutaneous injection. 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. 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. Low molecular
weight heparins are less effective at inactivating factor IIa due
to their shorter length compared to unfractionated heparin.
Indications and Dosages :
➤➤To prevent deep vein thrombosis (DVT) after hip or knee
replacement and for continued prophylaxis after hospitalization for
Adults. 30 mg every 12 hr, starting 12 to 24 hr after surgery for up to 14
days. Or, 40 mg daily, starting 9 to 15 hr after hip replacement
surgery. Prophylaxis: 40 mg daily for 3 wk.
➤➤To prevent DVT after abdominal surgery for patients with
thromboembolic risk factors (over age 40, obesity, general
anesthesia lasting longer than 30 minutes, cancer, or a history of
DVT or pulmonary embolism)
Adults. 40 mg daily, starting 2 hr before surgery and lasting 7 to 10
➤➤To prevent ischemic complications of unstable angina and
Adults. 1 mg/kg every 12 hr with 100 to 325 mg of aspirin daily for 2 to 8
days or until condition is stable.
dosage adjustment Dosage reduced to 30 mg daily if creatinine clearance is less than
30 ml/min/1.73 m2 and patient is receiving drug as prophylaxis in
abdominal, hip, or knee replacement surgery or is acutely ill.
Reduced to 1 mg/kg daily if creatinine clearance is less than 30
ml/ min/1.73 m2 and drug is given with aspirin to prevent ischemic
complications of unstable angina and non–Q-wave MI, with warfarin
as inpatient treatment for acute DVT with or without pulmonary
embolism, or with warfarin as outpatient treatment of acute DVT
without pulmonary embolism.
➤➤To treat acute ST-segment–elevation MI (STEMI)
i.v. injection, then subcutaneous injection
Adults. 30 mg I.V. as a single dose, followed by 1 mg/kg subcutaneously
(maximum, 100 mg for first two doses). Then, 1 mg/kg subcutaneously
every 12 hr.
dosage adjustment If patient also receives a thrombolytic, enoxaparin should be
given 15 to 30 min before and 30 min after fibrinolytic therapy
starts. If patient has percutaneous coronary intervention, give
0.3-mg/kg I.V. bolus if last enoxaparin dose was given more than 8
hr before balloon inflation.
Route Onset Peak Duration
SubQ Unknown 3–5 hr Up to 24 hr
Enoxaparin is a highly acidic mucopolysaccharide formed of equal
parts of sulfated D-glucosamine and D-glucuronic acid with
sulfaminic bridges. The molecular weight ranges from 3800 to 5000
daltons. Enoxaparin occurs in and is obtained from liver, lung,
mast cells, etc., of vertebrates. Enoxaparin is a well known and
commonly used anticoagulant which has antithrombotic properties.
Enoxaparin inhibits reactions that lead to the clotting of blood
and the formation of fibrin clots both in vitro and in vivo.
Enoxaparin acts at multiple sites in the normal coagulation system.
Small amounts of enoxaparin in combination with antithrombin III
(enoxaparin cofactor) can inhibit thrombosis by inactivating
activated Factor X and inhibiting the conversion of prothrombin to
thrombin. Once active thrombosis has developed, larger amounts of
enoxaparin can inhibit further coagulation by inactivating thrombin
and preventing the conversion of fibrinogen to fibrin. Enoxaparin
also prevents the formation of a stable fibrin clot by inhibiting
the activation of the fibrin stabilizing factor. Its use should be
avoided in patients with a creatinine clearance less than 20mL/min.
In these patients, unfractionated heparin should only be used. As
for monitoring, active partial thromboplastin time (aPTT) will only
increase at high doses of low molecular weight heparins (LMWH).
Therefore, monitoring aPTT is not recommended. However, anti-Xa
activity can be measured to monitor the efficacy of the LMWH.
Mechanism of action :
The mechanism of action of enoxaparin is antithrombin-dependent. It
acts mainly by accelerating the rate of the neutralization of
certain activated coagulation factors by antithrombin, but other
mechanisms may also be involved. The antithrombotic effect of
enoxaparin is well correlated to the inhibition of factor Xa.
Enoxaparin interacts with Antithrombin III, Prothrombin and Factor
X. 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.