Enoxaparin Sodium
Enoxaparin is a **low molecular weight heparin (LMWH)** used primarily for the prophylaxis and treatment of thromboembolic disease, such as deep vein thrombosis (DVT), pulmonary embolism (PE), and feline aortic thromboembolism (FATE). Compared to standard unfractionated heparin (UFH), LMWHs like enoxaparin offer a more predictable pharmacokinetic profile and preferentially inhibit Factor Xa over thrombin. This selective action means that standard coagulation tests (like aPTT) are not significantly prolonged, making hemorrhage less likely but also making monitoring more specialized. **Clinical Pearls:** * While LMWHs are theoretically safer and more predictable than UFH in humans, their rapid clearance in dogs and cats necessitates frequent subcutaneous dosing (often every 6 hours). * This frequent dosing schedule, combined with the high cost of the medication, can make long-term management challenging in veterinary medicine, particularly for large dogs or horses. * Recent studies in cats suggest that anti-Xa activity levels may not perfectly correlate with actual antithrombotic efficacy, complicating therapeutic monitoring.
Mecanismo: Enoxaparin exerts its anticoagulant effect by binding to and accelerating the activity of **antithrombin III (ATIII)**. * The enoxaparin-ATIII complex preferentially inhibits **Factor Xa** (→ blocking the conversion of prothrombin to thrombin in the coagulation cascade). * Because of its smaller molecular size compared to unfractionated heparin, enoxaparin has minimal impact on **thrombin (Factor IIa)**. * This selective anti-Xa activity prevents clot formation and extension without significantly altering standard clotting times (TT or aPTT).
Dosificación por especie
- Anticoagulant therapy · 1 mg/kg SC q12h · SC · q12h · Results in a measurable antithrombotic effect in healthy cats.
- Anticoagulant therapy · 1.5 mg/kg SC q6h · SC · q6h · Required to maintain a therapeutic target of anti-XA activity of 0.5-1 IU/mL.
- Anticoagulant therapy · 1.25 mg/kg SC q6h · SC · q6h · Current recommendations based on research in healthy cats.
- Anticoagulant therapy · No published dosage recommendation at the time of writing. · SC · q24h · Study demonstrated drug has similar activity as in humans and once daily SC injections may be useful.
- Anticoagulant therapy · 0.8 mg/kg SC q6h · SC · q6h · Appears to effectively and consistently maintain therapeutic levels of anti-Xa in normal dogs.
- Anticoagulant therapy · 0.8-1 mg/kg SC q6-8h · SC · q6-8h
Las dosis son una referencia clínica para médicos veterinarios. Confirme siempre con la información vigente del producto y el paciente individual.
Vías de administración
Contraindicaciones
- Hypersensitivity to enoxaparin, other LMWHs, heparin, or porcine products
- Intramuscular (IM) or Intravenous (IV) administration (must be given SC only)
Efectos adversos
- Hemorrhage (unlikely but possible)
- Injection site hematoma
- Anemia
- Thrombocytopenia
- Nausea
- Fever
- Asymptomatic, reversible increases in AST or ALT
Interacciones farmacológicas
- Warfarin (Oral Anticoagulants) · Increased risk for hemorrhage
- Aspirin · Increased risk for hemorrhage
- Clopidogrel · Increased risk for hemorrhage
- Thrombolytic Agents · Increased risk for hemorrhage
Monitoreo
- CBC (with platelet count); baseline and ongoing during therapy
- Urinalysis
- Stool occult blood test
- Factor Xa activity (useful if bleeding occurs or patient has renal dysfunction)
- Note: Routine coagulation tests (aPTT, PT) are usually insensitive measures of activity and usually not warranted
Sobredosis
Overdosage may lead to **hemorrhagic complications**. If treatment is necessary, **protamine sulfate** may be administered via slow IV as an antidote. * **Dose:** 1 mg of protamine sulfate can inhibit the effects of 1 mg of enoxaparin.
La referencia de fármacos de VetSheet está destinada a médicos veterinarios como apoyo a la decisión clínica; no sustituye el juicio profesional ni la información vigente del fabricante.