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image of Enoxaparin Sodium: An Updated Review

Abstract

Introduction

Therapeutic anticoagulation is essential for the prevention and treatment of both venous and arterial thromboembolic events. This study aims to present clinically relevant evidence on the use of enoxaparin (also known as Lovenox or Clexane) in various conditions, including stroke and atrial fibrillation.

Methods

This focused literature review was conducted using keywords relevant to the research topic in PubMed, Scopus, and Web of Science. The reference lists of eligible articles published up to April 29th, 2025, were also screened to identify additional studies of relevance to the aims of the investigation. Comprehensive, methodologically appropriate, well-informed, and high-quality articles were selected for inclusion (n = 102).

Results

Enoxaparin is an anticoagulant that inhibits clot formation by enhancing antithrombin-mediated inactivation of factor Xa (and, to a lesser extent, factor IIa), but its use is associated with an increased risk of bleeding. Factor XI plays a minimal role in physiological hemostasis but contributes substantially to thrombus propagation, making it an appealing therapeutic target for reducing bleeding risk while maintaining antithrombotic efficacy. To achieve the desired therapeutic effect, individualized dosing strategies may be required, particularly in women, who may have different pharmacokinetic responses compared with men. The standard treatment dose of enoxaparin is 1 mg/kg administered every 12 hours for the prevention and treatment of thromboembolic events in various clinical conditions. Dose adjustments may be necessary in patients with impaired kidney function, whereas individuals with obesity often require standard or higher, not lower, weight-based doses to achieve therapeutic anti-Xa levels.

Discussion

Early initiation of direct oral anticoagulants (DOACs) after ischemic stroke has been shown to reduce the risk of recurrent thromboembolic events and vascular death within the first 30 days in appropriately selected patients. Enoxaparin should be used cautiously with nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen, ibuprofen, or aspirin, because these agents impair platelet function and increase the risk of bleeding. In addition, antiplatelet medications, including prasugrel, ticagrelor, and clopidogrel, as well as certain herbal supplements, such as ginkgo biloba, fish oil, garlic, ginseng, and ginger, may further inhibit platelet function and heighten bleeding risk.

Conclusion

To evaluate efficiency and hemorrhage risk, anti-Xa agents may serve as a therapeutic option in populations treated with enoxaparin for thromboembolic disorders. Hemorrhagic bullous dermatosis, hepatotoxicity, loss of control or numbness, hypoaldosteronism, osteoporosis, and thrombocytopenia are some are some reported side effects of enoxaparin. A considerably lower dose of enoxaparin should be prescribed in women due to sex differences when compared to men.

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/content/journals/cdth/10.2174/0115748855413930251126045556
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Enoxaparin Sodium: An Updated Review
Bentham Science Publishers ; https://doi.org/10.2174/0115748855413930251126045556
/content/journals/cdth/10.2174/0115748855413930251126045556
/content/journals/cdth/10.2174/0115748855413930251126045556
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  • Article Type:     Review Article
Keywords: thromboembolism ; hemorrhage ; Enoxaparin ; venous thromboembolism ; thrombosis ; ischemic stroke

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