The prevention of thrombus formation in the extracorporeal circulation during haemodialysis.
In the United States, enoxaparin is FDA approved for eight indications:
Prophylaxis of DVT in medically ill patient,
Total hip & knee replacement,
Treatment of DVT with or with out PE inpatient and
Treatment of DVT inpatient, with ACS, including STEMI.
Mechanism of action
Enoxaparin binds to and accelerates the activity of antithrombin III. By activating antithrombin III, enoxaparin preferentially potentiates the inhibition of coagulation factors Xa and IIa. The anticoagulant effect of enoxaparin can be directly correlated to its ability to inhibit factor Xa. Factor Xa catalyzes the conversion of prothrombin to thrombin, so enoxaparin’s inhibition of this process results in decreased thrombin and ultimately the prevention of fibrin clot formation.
Enoxaparin does not affect the INR, PT or aPTT
Anti-factor Xa levels can be measured, and are often used to monitor enoxaparin activity
Category B: enoxaprin is safe for use in the second trimester as it does not cross the placenta
Protamine, although not as effective at reversal as it is for heparin due to more activity at the Xa clotting factor (enoxaparin); as heparin has both Xa and IIa. Protamine sulfate will reverse enoxaparin by 66% per package insert.