Enoxaparin (Vascular)

How it works

It binds antithrombin to inhibit factor Xa more than thrombin, producing predictable anticoagulation that reduces venous and arterial thrombus formation.

Prescribing in practice

• It accumulates in renal impairment, so dose reduction and consideration of anti-Xa monitoring are needed when renal function is significantly reduced to limit bleeding.
• Heparin-induced thrombocytopenia can occur, so platelet counts should be checked during prolonged treatment and enoxaparin stopped if it develops.
• Spinal or epidural haematoma is a risk with neuraxial anaesthesia, requiring careful timing around procedures.

Monitoring

Routine coagulation monitoring is unnecessary, but check platelets in extended use and use anti-Xa levels to guide dosing in renal impairment, pregnancy or extremes of body weight.

Counselling the patient

• It is injected under the skin; rotate sites and do not expel the small air bubble in pre-filled syringes.
• Report unusual bruising or bleeding.
• Keep to the prescribed dose and timing, especially around any planned procedure.

Evidence & guidelines

Trials across venous thromboembolism prophylaxis, treatment and acute coronary syndromes established enoxaparin's efficacy and predictable dosing, underpinning wide UK use.