Notes & Sources

• Regimens shown — Treatment: 1 mg/kg every 12 h, or 1 mg/kg every 24 h when CrCl is below 30 mL/min. Prophylaxis: 40 mg every 24 h, reduced to 30 mg every 24 h below CrCl 30 mL/min.
• Use Cockcroft-Gault creatinine clearance, not eGFR. The renal thresholds in the labelling were derived using Cockcroft-Gault, and the two diverge most in exactly the patients where the decision matters.
• Obesity. Treatment dosing on actual body weight is generally retained, but anti-Xa monitoring is commonly recommended above roughly 150 kg. Prophylactic doses are often increased in class III obesity — follow your local protocol.
• Peak anti-Xa is drawn 4 hours after a dose at steady state, once 3 to 4 doses have been given. Consider it in renal impairment, pregnancy, obesity and low body weight.
• Low molecular weight heparins are not interchangeable unit for unit. These figures apply to enoxaparin only.