Low-molecular-weight heparin. Binds antithrombin and inhibits mainly factor Xa, with less anti-thrombin effect. Predictable dosing without routine monitoring.
Dosing
Adult
Prophylaxis: 40 mg SC daily (trauma often 30 mg every 12 hours). Treatment: 1 mg/kg SC every 12 hours or 1.5 mg/kg daily
CrCl <30 mL/min: prophylaxis 30 mg daily; treatment 1 mg/kg once daily. Protamine only partly reverses it.
Indications
VTE prophylaxis in medical, surgical and trauma patients
Treatment of DVT and stable pulmonary embolism
Acute coronary syndromes
Contraindications
Active major bleeding
History of HIT
Use with caution with neuraxial anesthesia (spinal/epidural hematoma boxed warning)
Side effects
Bleeding
Injection-site bruising
Thrombocytopenia, including HIT (less than with heparin)
Hyperkalemia
Monitoring parameters
Platelet count
Renal function
Anti-Xa level in renal impairment, obesity, pregnancy
Drug interactions
Increased bleeding with antiplatelets, NSAIDs, other anticoagulants