Enoxaparin sodium

(Lovenox®)

Lovenox®

Drug updated on 5/17/2024

Dosage FormInjection (subcutaneous/intravenous; 100mg/mL [30 mg/0.3 mL, 40 mg/0.4 mL, 60 mg/0.6 mL, 80 mg/0.8 mL, 100 mg/1 mL, 300 mg/3 mL]); Injection (subcutaneous/intravenous; 150 mg/mL [120 mg/0.8 mL, 150 mg/1 mL])
Drug ClassLow molecular weight heparin
Ongoing and
Completed Studies
ClinicalTrials.gov

Indication

  • Indicated for prophylaxis of deep vein thrombosis (DVT) in abdominal surgery, hip replacement surgery, knee replacement surgery, or medical patients with severely restricted mobility during acute illness.
  • Indicated for inpatient treatment of acute DVT with or without pulmonary embolism.
  • Indicated for outpatient treatment of acute DVT without pulmonary embolism.
  • Indicated for prophylaxis of ischemic complications of unstable angina and non–Q-wave myocardial infarction (MI).
  • Indicated for treatment of acute ST-segment elevation myocardial infarction (STEMI) managed medically or with subsequent percutaneous coronary intervention (PCI).

Summary
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  • Enoxaparin sodium (Lovenox) is indicated for prophylaxis of deep vein thrombosis in abdominal surgery, hip replacement surgery, knee replacement surgery, or medical patients with severely restricted mobility during acute illness. It is also used for the treatment of acute DVT with or without pulmonary embolism and ischemic complications of unstable angina and non-Q-wave myocardial infarction.
  • The information was derived from 10 systematic reviews/meta-analyses that compared Lovenox against a range of anticoagulants such as fondaparinux, aspirin, and various non-vitamin K antagonist oral anticoagulants like apixaban, rivaroxaban, and dabigatran.
  • In terms of safety and effectiveness comparison to other drugs for VTE prevention after total hip arthroplasty (THA) and general surgeries, enoxaparin showed variable effectiveness depending on the patient subgroup/surgical context. However, it outperformed placebo in trauma settings without an increased risk of bleeding, indicating its safety and efficacy.
  • Population types/subgroup considerations revealed that fixed dosing regimens did not always correlate with adequate anti-Xa levels, suggesting potential inadequacies in prevention for some patient populations, including those undergoing general surgeries. Specific dosing recommendations were suggested for obese patients due to complexities associated with effective dosing among individuals having higher BMIs.
  • Safety comparisons, particularly regarding bleeding risks, were consistent across studies, showing a balanced risk profile, except in certain exceptions where variable results were reported when directly compared to specific NOACs. Aspirin was considered a non-inferior option after elective arthroplasty, showing no significant difference in bleeding events, though the quality of evidence varied from low to very low.
  • Administration twice daily was hinted at being possibly more effective than once-daily dosage, especially among certain population groups without significantly increasing major hemorrhagic complications, emphasizing the importance of personalized medicine based on individual characteristics, surgical type, and risk factors.

Product Monograph / Prescribing Information

Document TitleYearSource
Lovenox (enoxaparin sodium) Prescribing Information.2021Sanofi-aventis, Bridgewater, NJ

Systematic Reviews / Meta-Analyses

Document TitleYearSource
Antithrombotic prophylaxis following total hip arthroplasty: a level I Bayesian network meta-analysis.2024Journal of Orthopaedics and Traumatology
The efficacy of various Enoxaparin dosing regimens in general surgery patients: a systematic review.2023Surgery
The effectiveness of venous thromboembolism prophylaxis interventions in trauma patients: a systematic review and network meta-analysis.2023Injury
Efficacy and safety of enoxaparin versus new oral anticoagulants to prevent venous thromboembolism after total hip replacement: a systematic review and meta-analysis.2022Journal of Personalized Medicine
Comparison of the efficacy and safety of rivaroxaban and enoxaparin as thromboprophylaxis agents for orthopedic surgery-systematic review and meta-analysis.2022Journal of Clinical Medicine
Low anti-Factor Xa level predicts 90-day symptomatic venous thromboembolism in surgical patients receiving enoxaparin prophylaxis: a pooled analysis of eight clinical trials.2022Annals of Surgery
Aspirin versus enoxaparin for the initial prevention of venous thromboembolism following elective arthroplasty of the hip or knee: a systematic review and meta-analysis.2021Orthopaedics & Traumatology: Surgery & Research
Dosage of anticoagulants in obesity: Recommendations based on a systematic review.2020Seminars in Thrombosis and Hemostasis
Safety and efficacy of enoxaparin in pregnancy: a systematic review and meta-analysis.2020Advances in Therapy
Once-daily vs. twice-daily dosing of enoxaparin for the management of venous thromboembolism: a systematic review and meta-analysis.2020Experimental and Therapeutic Medicine

Clinical Practice Guidelines