What weight should be used for enoxaparin dosing in obesity?

For BMI ≤40 or weight >190 kg: anti-Xa monitoring is essential; some guidelines use actual body weight with a cap at 180 mg q12h; weight-based dosing at 1 mg/kg q12h using actual body weight is generally recommended for treatment doses.

When is anti-Xa monitoring required for enoxaparin?

Anti-Xa monitoring recommended in: morbid obesity (BMI>40), weight <45 kg, renal impairment (CrCl 15-30 mL/min), pregnancy, and patients not responding clinically; therapeutic range 0.5-1.2 IU/mL (q12h dosing) or 1.0-2.0 IU/mL (q24h).

How should enoxaparin be adjusted for renal impairment?

CrCl 15-30 mL/min: reduce to 1 mg/kg q24h for treatment; CrCl <15 mL/min: unfractionated heparin preferred (better reversible with anti-Xa monitoring); prophylaxis 20 mg q24h for CrCl 15-30.

What is the enoxaparin bridging protocol for warfarin?

Enoxaparin 1 mg/kg q12h or 1.5 mg/kg q24h overlapping with warfarin initiation; overlap for minimum 5 days AND until INR ≥2.0 for ≥2 consecutive days; then discontinue LMWH.

Can enoxaparin be partially reversed with protamine?

Protamine reverses only ~60% of enoxaparin anti-Xa activity; 1 mg protamine per 1 mg enoxaparin within 8h; 0.5 mg protamine per 1 mg enoxaparin if 8-12h post-dose; incomplete reversal compared to UFH.

Enoxaparin (LMWH) Weight-Based Dosing and Anti-Xa Monitoring

Calculates enoxaparin dosing for VTE treatment (1 mg/kg q12h or 1.5 mg/kg q24h), prophylaxis (40 mg q24h), and ACS (1 mg/kg q12h), with anti-Xa monitoring thresholds for obesity, pregnancy, and renal failure.

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Frequently Asked Questions

What weight should be used for enoxaparin dosing in obesity?

When is anti-Xa monitoring required for enoxaparin?

How should enoxaparin be adjusted for renal impairment?

What is the enoxaparin bridging protocol for warfarin?

Can enoxaparin be partially reversed with protamine?