Adjusting Enoxaparin by Weight for DVT Prophylaxis

"Enoxaparin sodium is a subcutaneously (SC) administered low-molecular-weight heparin approved in the United States for the inpatient or outpatient treatment of deep venous thrombosis (DVT) in place of standard heparin infusion. It may also be used as DVT prophylaxis in patients undergoing general or orthopaedic surgery. The standard prophylactic dose of enoxaparin for orthopaedic surgery is 30 mg SC twice daily with the initial dose administered within 12-24 hours of surgery, or 40 mg once daily with the initial dose administered within 9-15 hours before surgery and continuing for 7-10 days or until the risk of DVT has diminished. For major general surgery, the recommended dose is 40 mg SC once daily with initial dose given 2 hours before surgery and continuing for about 7-10 days. Although there is no approved dose for weight-based enoxaparin for use as DVT prophylaxis, I would not recommend exceeding 0.5 mg/kg every 12 hours."