Enoxaparin (VTE Prophylaxis — Post-Surgery)

How it works

It binds antithrombin and accelerates inhibition of factor Xa more than thrombin, reducing fibrin formation and clot propagation.

Prescribing in practice

• Bleeding is the main hazard, so observe strict timing intervals relative to spinal or epidural anaesthesia and catheter removal to minimise the risk of spinal haematoma.
• Reduce the prophylactic dose in significant renal impairment because of accumulation, and consider anti-Xa monitoring where clearance is uncertain.
• Monitor for heparin-induced thrombocytopenia and avoid in active major bleeding or heparin hypersensitivity.

Monitoring

Monitor platelet count, renal function and for signs of bleeding, reserving anti-Xa levels for selected patients such as those with renal impairment.

Counselling the patient

• Report unexpected bruising, bleeding or black stools.
• Mention any planned spinal or epidural procedure so injection timing can be managed.

Evidence & guidelines

Postoperative VTE prophylaxis with enoxaparin is supported by NICE NG89 and extensive randomised trial evidence.