Enoxaparin Dosing in Acute Coronary Syndrome
Initial Therapy Dosing
- The American College of Cardiology recommends an initial dose of enoxaparin of 1 mg/kg subcutaneously every 12 hours for standard initial therapy in acute coronary syndrome (ACS) patients 1, 2, 4
- For patients with renal impairment (CrCl <30 mL/min), the American College of Cardiology recommends reducing the dose to 1 mg/kg subcutaneously once daily 1, 3
- An initial intravenous loading dose of 30 mg has been used in selected patients, though this is not mandatory for all patients, as per the American College of Cardiology 5, 6, 7
Dosing When Supporting PCI
- For patients who have received prior enoxaparin treatment and are proceeding to PCI, the American College of Cardiology recommends administering an IV dose of 0.3 mg/kg if the last subcutaneous dose was administered 8-12 hours earlier or only 1 subcutaneous dose has been given 1, 4, 8
- If the last dose was administered within the previous 8 hours, the American College of Cardiology recommends no additional enoxaparin 1, 4
- For patients who have not received prior anticoagulant therapy, the American College of Cardiology recommends a 0.5-0.75 mg/kg IV bolus 1, 4
Dosing With Fibrinolytic Therapy
- For patients <75 years, the American College of Cardiology recommends a 30 mg IV bolus, followed in 15 minutes by 1 mg/kg subcutaneously every 12 hours (maximum 100 mg for first 2 doses) 1, 4, 3
- For patients ≥75 years, the American College of Cardiology recommends no bolus, 0.75 mg/kg subcutaneously every 12 hours (maximum 75 mg for first 2 doses) 1, 4, 3
- Regardless of age, if CrCl <30 mL/min, the American College of Cardiology recommends 1 mg/kg subcutaneously every 24 hours 1, 4, 3
Duration of Therapy
- The American College of Cardiology recommends that enoxaparin should be continued for the duration of hospitalization or until PCI is performed 1, 9
- The American College of Cardiology also notes that premature discontinuation of anticoagulation is associated with a rebound increase in thrombin activity and risk of reinfarction, with greatest risk in the first 4-8 hours after discontinuation 1