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How it is administered
Enoxaparin is given as an injection, either under the skin (subcutaneous) or, in some cases, directly into a vein (intravenous). It comes in prefilled syringes, graduated prefilled syringes, and multiple-dose vials. The prefilled syringes are for single use only and do not contain preservatives. The multiple-dose vials contain benzyl alcohol as a preservative and should not be used in infants or pregnant women when possible.
For most uses, enoxaparin is injected subcutaneously into the fatty tissue of the abdomen. Patients may be taught to self-inject at home if needed. The dose and frequency depend on the condition being treated and individual patient factors.
How it works
Enoxaparin is a type of medication known as a low molecular weight heparin (LMWH). It works by preventing blood clots from forming. It does this by blocking certain clotting factors in the blood, mainly Factor Xa and, to a lesser extent, Factor IIa (thrombin). By inhibiting these factors, enoxaparin reduces the blood's ability to clot, which helps prevent dangerous clots from forming in the veins or arteries.
Enoxaparin is absorbed quickly after injection, and its effects last for several hours. It is mainly used to prevent or treat blood clots in people who are at risk, such as those who are immobile due to illness or surgery. It is also used in some heart conditions to prevent complications from clots. The medication is processed by the liver and kidneys, so dose adjustments may be needed for people with kidney problems.
Common side effects
- Bleeding (including nosebleeds, bruising, or more serious internal bleeding)
- Anemia
- Low platelet count (thrombocytopenia)
- Elevated liver enzymes
- Diarrhea
- Nausea
- Bruising or pain at the injection site
- Fever
- Swelling (edema)
- Shortness of breath (dyspnea)
- Confusion
Serious but less common side effects include spinal/epidural hematomas (which can cause paralysis), severe allergic reactions, and skin reactions at the injection site.
Who Should take it
Enoxaparin is used to prevent and treat blood clots, especially in people who are at higher risk due to surgery, immobility, or certain medical conditions. It is commonly given to patients after abdominal, hip, or knee surgery, and to those who are bedridden due to acute illness. It is also used to treat deep vein thrombosis (DVT) and pulmonary embolism (PE), both in hospital and outpatient settings, usually in combination with other blood thinners like warfarin.
In patients with certain heart conditions, such as unstable angina or heart attacks, enoxaparin can help prevent further clot-related complications when used with aspirin. While not specifically indicated for chronic eosinophilic leukemia, people with blood cancers may be at increased risk for blood clots, and enoxaparin may be used to prevent or treat these complications as directed by a healthcare provider.
Who should not take it
Enoxaparin should not be used in people who have active major bleeding, a history of immune-mediated heparin-induced thrombocytopenia (HIT) within the past 100 days, or in the presence of circulating HIT antibodies. It is also contraindicated in those with known allergies to enoxaparin, heparin, pork products, or benzyl alcohol (the latter applies to the multiple-dose vial formulation).
Caution is needed in people with a high risk of bleeding, such as those with bleeding disorders, recent brain, spinal, or eye surgery, or severe uncontrolled high blood pressure. It should not be used interchangeably with other heparins or low molecular weight heparins, as dosing and effects can differ.
Commonly used with
Enoxaparin is often used together with other blood thinners, such as warfarin, especially when treating deep vein thrombosis or pulmonary embolism. In patients with heart conditions, it is commonly used with aspirin to prevent clot-related complications.
It is important to tell your doctor about all medications you are taking, as combining enoxaparin with other drugs that affect blood clotting (such as NSAIDs, other anticoagulants, or antiplatelet agents) can increase the risk of bleeding.
Commonly tested with
Enoxaparin is commonly studied and used in combination with warfarin for the treatment of deep vein thrombosis and pulmonary embolism. It is also tested with aspirin in the setting of heart attacks and unstable angina.
In clinical studies, enoxaparin has been compared to standard heparin and placebo in preventing and treating blood clots in various patient populations, including those with cancer, surgery, or acute illness.
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