Enoxaparin (VTE Prophylaxis — Post-Surgery)

Individual thromboembolic risk can be estimated using a validated risk stratification model. DURATION: moderate-risk patients — maintain treatment for a minimum period of 7-10 days whatever the recovery status (e.g. mobility), and continue prophylaxis until the patient no longer has significantly reduced mobility. High-risk patients undergoing MAJOR ORTHOPAEDIC SURGERY — extended thromboprophylaxis up to 5 weeks is recommended. Patients with high VTE risk undergoing ABDOMINAL OR PELVIC SURGERY FOR CANCER — extended thromboprophylaxis up to 4 weeks is recommended. If high-risk prophylaxis must start earlier than 12 hours before surgery (e.g. a high-risk patient awaiting deferred orthopaedic surgery), the last injection should be given no later than 12 hours prior to surgery and resumed 12 hours after surgery. OTHER INDICATIONS IN THE SAME SPC (not the dose above): prophylaxis in medical patients 4,000 IU (40 mg) SC once daily for at least 6 to 14 days; treatment of DVT and PE 150 IU/kg (1.5 mg/kg) SC once daily or 100 IU/kg (1 mg/kg) SC twice daily; unstable angina/NSTEMI 100 IU/kg (1 mg/kg) SC every 12 hours; acute STEMI single IV bolus of 3,000 IU (30 mg) plus 100 IU/kg (1 mg/kg) SC then 100 IU/kg (1 mg/kg) SC every 12 hours (maximum 10,000 IU (100 mg) for each of the first two SC doses). NEURAXIAL ANAESTHESIA (§4.2): at PROPHYLACTIC doses a puncture-free interval of at least 12 hours must be kept between the last enoxaparin injection and needle or catheter placement, and a similar delay of at least 12 hours before removing the catheter; for creatinine clearance 15-30 mL/min consider doubling these intervals to at least 24 hours; 'The 2 hours preoperative initiation of enoxaparin sodium 2,000 IU (20 mg) is not compatible with neuraxial anaesthesia.' Consider not using enoxaparin until at least 4 hours after the spinal/epidural puncture or after catheter removal. At TREATMENT doses the puncture-free interval is at least 24 hours (48 hours if creatinine clearance 15-30 mL/min). §4.4: enoxaparin cannot be used interchangeably (unit for unit) with other low molecular weight heparins; measure platelet counts before initiation and regularly thereafter. PAEDIATRIC: 'The safety and efficacy of enoxaparin sodium in paediatric population have not been established' — no paediatric dose is stated, so paedDose is null. ELDERLY: for all indications except STEMI, no dose reduction is necessary unless kidney function is impaired. HEPATIC IMPAIRMENT: limited data — use with caution. PROVENANCE NOTE: the interactions listed in this draft come from the US label section 7 (openFDA), because no UK SPC §4.5 was present in the fetched bundle; the dose, contraindications, pregnancy and adverse-effect content come from the UK SPC.