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Mythbuster: Maximum Dose of Enoxaparin

Posted Mar 27 2013 12:00am

Venous thromboembolism (VTE) is often treated with low molecular weight heparins (LMWH) such as enoxaparin. For patients with normal renal function, dosing is as follows
  • Enoxaparin: 1 mg/kg subcutaneously every 12 hours, or 1.5 mg/kg every 24 hours 
  • Dalteparin 200 IU/kg subcutaneously once daily 
  • Tinzaparin: 175 IU/kg subcutaneously once daily

What about the obese patient?
Is there a maximum dose for enoxaparin?

Myth busted: 
There is NO maximum enoxaparin dose for treatment of VTE.

Supporting Data
Studies have evaluated dosing for patients weighing up to 190 kg and found the 1 mg/kg q12 hour dosing to be safe and effective. It can even be used for patients heavier than 190 kg, but anti-Xa monitoring is recommended.

Key Points
  • Dosing should be based on total body weight. 
  • In patients with a BMI > 27, use the q12 hour dosing (not q24 hours). 
  • Doses should not be capped for VTE treatment (studies differ on whether or not to cap in treatment of acute coronary syndrome). 
  • In patients > 190 kg, it is recommended to monitor anti-Xa levels if available.

Nutescu EA, Spinler SA, Wittkowsky A, et al. Low-molecular-weight heparins in renal impairment and obesity: available evidence and clinical practice recommendations across medical and surgical settings. Ann Pharmacother 2009;43(6):1064-83. [ PMID 19458109 ]

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