依諾肝素鈉
Enoxaparin Sodium
Enoxaparinum natricum
別名: Lovenox · Clexane · Decipar · Klexane · Plaucina · Trombenox · Enoxaparinum natricum · PK10169 · RP-54563 · Low molecular weight heparin · LMWH
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
經審核的 v13 劑量證據
結構化劑量計算證據Thromboprophylaxis (extra-label)
須由已驗證獸醫確認
- q6-12h
NA
必須一併考量的臨床脈絡 (2)
- The commercially available injection should be stored at room temperature (25°C [77°F]); excursions permitted to 15°C to 30°C (59°F-86°F).
- One study showed that diluting the 100 mg/mL commercially available solution with sterile water to 20 mg/mL resulted in a product that was stable for 4 weeks when stored in a glass vial or in plastic syringes at room temperature or refrigerated. 18
劑量為合格獸醫專業人員的臨床參考。請務必對照最新仿單及個別病患確認。
概覽
依諾肝素是一種低分子量肝素 (LMWH)，主要用於預防和治療血栓栓塞性疾病，如深靜脈血栓 (DVT)、肺栓塞 (PE) 和貓主動脈血栓栓塞 (FATE)。
與標準的未分級肝素 (UFH) 相比，依諾肝素等 LMWH 提供更可預測的藥代動力學特徵，並優先抑制凝血因子 Xa 而非凝血酶。這種選擇性作用意味著標準凝血測試（如 aPTT）不會顯著延長，從而降低了出血的可能性，但也使得監測需要更專業的檢驗。
臨床要點：
- 雖然 LMWH 在人類中理論上比 UFH 更安全且更可預測，但它們在犬貓體內的快速清除需要頻繁的皮下給藥（通常每 6 小時一次）。
- 這種頻繁的給藥時間表，加上藥物的高昂成本，可能使獸醫學中的長期管理變得困難，特別是對於大型犬或馬。
- 最近針對貓的研究表明，抗 Xa 活性水平可能與實際的抗血栓功效並不完全相關，這增加了治療監測的複雜性。
作用機轉
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).
安全性與警告
禁忌症
- Hypersensitivity to enoxaparin, other LMWHs, heparin, or porcine products
- Intramuscular (IM) or Intravenous (IV) administration (must be given SC only)
不良反應
- Hemorrhage (unlikely but possible)
- Injection site hematoma
- Anemia
- Thrombocytopenia
- Nausea
- Fever
- Asymptomatic, reversible increases in AST or ALT
注意事項
Use cautiously in patients with significant renal dysfunction, as drug accumulation could result.
Important: Do NOT administer via IM or IV routes; enoxaparin must be given via deep subcutaneous injection only. Enoxaparin cannot be used interchangeably with other LMWHs (e.g., dalteparin) or unfractionated heparin sodium because the dosages and anti-Xa activities differ for each product.
藥物交互作用
Increased risk for hemorrhage
Increased risk for hemorrhage
Increased risk for hemorrhage
Increased risk for hemorrhage
監測
- 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
藥物動力學
半衰期
吸收
After SC injection in humans, absorbed rapidly with a bioavailability of about 92%; peak plasma levels (activity) occur in 3-5 hours.
分佈
Anti-factor Xa activity persists for up to 24 hours in humans, but duration is significantly shorter in dogs and cats.
代謝
Metabolized in the liver.
排除
Excreted in the urine as both unchanged drug and metabolites.
過量
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.
可用產品
劑型
- Injection (prefilled syringes)
- Injection (multidose vials)
人用標示
- Enoxaparin Sodium for Injection: 30 mg/0.3 mL, 40 mg/0.4 mL, 60 mg/0.6 mL, 80 mg/0.8 mL, 100 mg/1 mL, 120 mg/0.8 mL, & 150 mg/1 mL preservative free in single-dose prefilled syringes
- Enoxaparin Sodium for Injection: 300 mg/3 mL containing 15 mg/mL benzyl alcohol in 3 mL multidose vials (Lovenox)
各地核准狀態
暫無法規資料: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
Store commercially available injection at room temperature (25°C, 77°F); excursions permitted to 15-30°C (59-86°F). Diluting 100 mg/mL solution with sterile water to 20 mg/mL is stable for 4 weeks when stored in a glass vial or plastic syringes at room temperature or refrigerated.
飼主須知
依諾肝素是一種血液稀釋劑，用於預防或治療危險的血栓。
- 給藥方式： 此藥物必須通過皮下注射給藥。您的獸醫會教您正確的注射技巧。如果不使用預充式注射器，請使用極細的胰島素或結核菌素注射器（例如 27 號針頭）。
- 嚴格的時間表： 完全按照處方給藥至關重要。如果漏服或延遲給藥，可能會形成危及生命的血栓。
- 注意出血： 因為這種藥物會防止血液凝固，所以有出血的風險。如果發現任何出血跡象（例如牙齦蒼白、瘀傷、流鼻血、黑色/柏油樣糞便或尿液中有血），請立即向您的獸醫報告。
- 注意血栓： 報告任何突然的虛弱、癱瘓（尤其是貓的後腿）、疼痛或呼吸困難，因為這些可能是新血栓形成的跡象。
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