Enoxaparin -- round off dose to nearest 10 mg for adults only.
For Obese Patients (therapeutic dosing): Maximum initial dose of 200 mg q12hr in patients > 200 kg receiving therapeutic enoxaparin (1 mg/kg q12hr). If 1 mg/kg is ordered and dose > 200 mg, pharmacists will automatically adjust doses to 200 mg per dose at verification with order comment "Dose adjustment per P&T". Anti-Xa level should be ordered for any patient whose dose has been “capped”.
For Obese Patients (prophylactic dosing): For patients whose BMI ≥ 40 kg/m2, prophylactic enoxaparin (40 mg daily) will be automatically converted to 40 mg q12h with order comment “Dose adjustment per P&T”. Exclusions: post-operative orthopedic, cardiothoracic, trauma, and general surgery patients; renal insufficiency (CrCl < 30 ml/min) requiring 30 mg q24h prophylactic dosing
Pregnancy and Postpartum: Do not make any automatic adjustments based on BMI or anti-Xa levels to enoxaparin orders in a pregnant or postpartum patient. Contact the provider if there are clinical concerns.
Pediatrics: Do not make any automatic adjustmentsbased on BMI or anti-Xa levels to enoxaparin ordersin a pediatric patient. Contact the provider if there are clinical concerns.
Pharmacists may automatically order Anti-Xa levels on patients where LMWH dosing may be problematic (i.e., renal compromise, obesity, pregnancy, etc.) per P&T policy. Dosing adjustments may be made automatically per Enoxaparin Dosing Nomogram and Obesity Considerations
Updated May 2022
Renal Dosing
Creatinine clearance (mL/min)
Conversion
Automatic?
Notes
<30
(prophylactic)
enoxaparin 40 mg Daily --> 30 mg Daily
enoxaparin 30 mg BID --> 30 mg Daily
YES
Enter with comment "Renal Dose Adjustment"
<30
(treatment)
enoxaparin 1 mg/kg q12 --> 1 mg/kg daily
YES
All other situations, contact prescriber for dosage adjustments
DVT prophylaxis of non-cardiac, non-trauma, non-orthopedic cases (including general medication patients and general/abdominal surgery)
Convert enoxaparin 30 mg BID to 40 mg DAILY
Enter with comment "Dose adjustment per P&T"
Pharmacists (through PKS) may automatically order Anti-Xa levels on patients where LMWH dosing may be problematic (i.e., renal compromise, obesity, pregnancy, etc.), with follow-up physician communication.
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Enoxaparin -- round off dose to nearest 10 mg for adults only.
For Obese Patients (therapeutic dosing): Maximum initial dose of 200 mg q12hr in patients > 200 kg receiving therapeutic enoxaparin (1 mg/kg q12hr). If 1 mg/kg is ordered and dose > 200 mg, pharmacists will automatically adjust doses to 200 mg per dose at verification with order comment "Dose adjustment per P&T". Anti-Xa level should be ordered for any patient whose dose has been “capped”.
For Obese Patients (prophylactic dosing): For patients whose BMI ≥ 40 kg/m2, prophylactic enoxaparin (40 mg daily) will be automatically converted to 40 mg q12h with order comment “Dose adjustment per P&T”. Exclusions: post-operative orthopedic, cardiothoracic, trauma, and general surgery patients; renal insufficiency (CrCl < 30 ml/min) requiring 30 mg q24h prophylactic dosing
Pregnancy and Postpartum: Do not make any automatic adjustments based on BMI or anti-Xa levels to enoxaparin orders in a pregnant or postpartum patient. Contact the provider if there are clinical concerns.
Pediatrics: Do not make any automatic adjustments based on BMI or anti-Xa levels to enoxaparin orders in a pediatric patient. Contact the provider if there are clinical concerns.
Pharmacists may automatically order Anti-Xa levels on patients where LMWH dosing may be problematic (i.e., renal compromise, obesity, pregnancy, etc.) per P&T policy. Dosing adjustments may be made automatically per Enoxaparin Dosing Nomogram and Obesity Considerations
Updated May 2022
<30
(prophylactic)
enoxaparin 40 mg Daily --> 30 mg Daily
enoxaparin 30 mg BID --> 30 mg Daily
<30
(treatment)
Automatic renal adjustment per guidelines. Renal Adjustment Guidelines
Approved Dosage Adjustments
SITUATION
RESPONSE
DVT prophylaxis of non-cardiac, non-trauma, non-orthopedic cases (including general medication patients and general/abdominal surgery)
Convert enoxaparin 30 mg BID to 40 mg DAILY
Enter with comment "Dose adjustment per P&T"
Pharmacists (through PKS) may automatically order Anti-Xa levels on patients where LMWH dosing may be problematic (i.e., renal compromise, obesity, pregnancy, etc.), with follow-up physician communication.
Low Molecular Weight Heparin Initiation and Maintenance
Pediatric enoxaparin dose rounding