Enoxaparin: A Perspective on Its Use for Coronary Artery Disease

Enoxaparin is commonly used in cardiac patients. As with all low molecular weight heparins, (LMWHs) the drug is easy to administer subcutaneously as compared with intravenous infusion of unfractionated heparin. Unlike other LMWHs, enoxaparin has been shown to be superior to intravenous unfractionated heparin in patients with non-ST elevation and ST elevation acute coronary syndromes (ACS), and a comparable agent in patients undergoing elective percutaneous coronary intervention (PCI) with decreased bleeding. However, elective PCI in patients without ACS is currently not in the enoxaparin label. It primarily inhibits factors Xa and IIa with a greater effect on factor Xa. Enoxaparin is renally cleared and a dose adjustment by 50% reduction is recommended for patients with creatinine clearance below 30 ml/min. In patients aged 75 years or older undergoing fibrinolysis, it is recommended that the intravenous bolus of 30 mg be omitted and that only 75% of the usually recommended dose of 1 mg/kg subcutaneously twice-daily be administered. Enoxaparin is the antithrombotic of choice in patients receiving fibrinolytic therapy, and is a good alternative in patients with non-ST elevation ACS (NSTEACS) and elective PCI. Further data are required for primary PCI in ST elevation myocardial infarction.