Enoxaparin requires individualized dosing, particularly lower doses for women due to sex differences in pharmacokinetics, to mitigate bleeding risks while maintaining efficacy.
This review highlights the clinical utility of enoxaparin for thromboembolic disorders while emphasizing the critical need for individualized dosing, particularly in women, and caution regarding bleeding risks and drug interactions.
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Introduction: Therapeutic anticoagulation is essential for the prevention and treat-ment of both venous and arterial thromboembolic events. This study aims to present clinically relevant evidence on the use of enoxaparin (also known as Lovenox or Clexane) in various conditions, including stroke and atrial fibrillation. Methods: This focused literature review was conducted using keywords relevant to the re-search topic in PubMed, Scopus, and Web of Science. The reference lists of eligible articles published up to April 29th, 2025, were also screened to identify additional studies of relevance to the aims of the investigation. Comprehensive, methodologically appropriate, well-in-formed, and high-quality articles were selected for inclusion (n = 102). Results: Enoxaparin is an anticoagulant that inhibits clot formation by enhancing antithrom-bin-mediated inactivation of factor Xa (and, to a lesser extent, factor IIa), but its use is asso-ciated with an increased risk of bleeding. Factor XI plays a minimal role in physiological hemostasis but contributes substantially to thrombus propagation, making it an appealing therapeutic target for reducing bleeding risk while maintaining antithrombotic efficacy. To achieve the desired therapeutic effect, individualized dosing strategies may be required, par-ticularly in women, who may have different pharmacokinetic responses compared with men. The standard treatment dose of enoxaparin is 1 mg/kg administered every 12 hours for the prevention and treatment of thromboembolic events in various clinical conditions. Dose ad-justments may be necessary in patients with impaired kidney function, whereas individuals with obesity often require standard or higher, not lower, weight-based doses to achieve ther-apeutic anti-Xa levels. Discussion: Early initiation of direct oral anticoagulants (DOACs) after ischemic stroke has been shown to reduce the risk of recurrent thromboembolic events and vascular death within the first 30 days in appropriately selected patients. Enoxaparin should be used cautiously with nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen, ibuprofen, or aspirin, be-cause these agents impair platelet function and increase the risk of bleeding. In addition, an-tiplatelet medications, including prasugrel, ticagrelor, and clopidogrel, as well as certain herbal supplements, such as ginkgo biloba, fish oil, garlic, ginseng, and ginger, may further inhibit platelet function and heighten bleeding risk. Conclusion: To evaluate efficiency and hemorrhage risk, anti-Xa agents may serve as a ther-apeutic option in populations treated with enoxaparin for thromboembolic disorders. Hemor-rhagic bullous dermatosis, hepatotoxicity, loss of control or numbness, hypoaldosteronism, osteoporosis, and thrombocytopenia are some are some reported side effects of enoxaparin. A considerably lower dose of enoxaparin should be prescribed in women due to sex differ-ences when compared to men.
Ahmad Chitsaz (Tue,) reported a other. Enoxaparin requires individualized dosing, particularly lower doses for women due to sex differences in pharmacokinetics, to mitigate bleeding risks while maintaining efficacy.
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