Enoxaparin

SJH Emergency Medicine
NHS Lothian

From 7th October NHS Lothian is switching from dalteparin to enoxaparin for anticoagulation.

The paediatrics team will continue to use dalteparin in children for thromboprophylaxis due to dosing frequency.

This document outlines the recommendations on dosing from pharmacy.

Prescribing - Switching from dalteparin to enoxaparin in adult patients

Patients receiving dalteparin Treatment recommendation
Thromboprophylaxis
Treatment of Venous Thromboembolism		 Switch to enoxaparin - refer to antithrombotic guide
for dosing
Complex patients with specialist/haematology input e.g. LMWH dosing adjusted by monitoring of
factor Xa levels, Bridging dose regimens		 Continue with dalteparin

Enoxaparin has several branded preparations available. Inhixa® is the product of choice in NHS Lothian.

Prophylaxis doses

Recommended doses from NHSL Pharmacy:

Weight (kg)

Dosage in CrCl ≥30ml/min

Dosage in CrCl 15-29 ml/min

Dosage in CrCl <15 ml/min
(including intermittent HD and CVVHD)

<50kg

20mg ONCE daily

20mg ONCE daily

For low to moderate thrombosis risk consider mechanical measures.

20mg ONCE daily

50-100kg

40mg ONCE daily

20mg ONCE daily

For low to moderate thrombosis risk consider mechanical measures.

20mg ONCE daily

101-150kg

40mg TWICE daily

40mg ONCE daily

40mg ONCE daily

>150kg

60mg TWICE daily*

40mg TWICE daily*

40mg ONCE daily*

*Monitoring of LMW Heparin assay (Anti-Xa) is recommended

Treatment doses

Recommended doses from NHSL Pharmacy. Note an asterisk(*) signifies that monitoring of LMW Heparin assay (Anti-Xa) is recommended.

Acute VTE- excludes active cancer or high risk features

Weight (kg)

Dosage in CrCl ≥30ml/min

Dosage in CrCl <30ml/min 
(including intermittent haemodialysis and CVVHD)

35-46kg

60mg ONCE daily 

40mg ONCE daily *

47-50kg

80mg ONCE daily

40mg ONCE daily *

51-60kg

80mg ONCE daily

60mg ONCE daily *

61-69kg

100mg ONCE daily

60mg ONCE daily *

70-73kg

100mg ONCE daily

80mg ONCE daily *

74-89kg

120mg ONCE daily

80mg ONCE daily *

90-109kg

150mg ONCE daily

100mg ONCE daily *

110-129kg

180mg (100mg PFS+80mg PFS) ONCE daily

120mg ONCE daily *

130-135kg

See Table 2 for dosing

120mg ONCE daily *

136-165kg

150mg ONCE daily *

166-200kg

180mg (100mg PFS + 80mg PFS) ONCE daily *

200kg+

Discuss with haematology

High-risk VTE

Weight (kg)

Dosage in CrCl >30ml/min

Dosage in CrCl<30ml/min

35-49kg

40mg TWICE daily

 

See Table 1 for dosing

50-69kg

60mg TWICE daily

 

70-89kg

80mg TWICE daily

 

90-129kg

100mg TWICE daily *

 

130-159kg

120mg TWICE daily *

 

160-200kg

150mg TWICE daily *

 

200kg+

Discuss with haematology

Route of administration

Dalteparin is licensed for administration by subcutaneous injection into the abdominal subcutaneous tissue or into the lateral part of the thigh. Whereas enoxaparin is only licensed for administration into abdominal subcutaneous tissue. Hence, administration into the thigh is an off-label route. However, subcutaneous injection of enoxaparin into the thigh is widely practiced in the UK.

A formulary application form is in progress to add administration into the thigh as an approved alternative route to abdominal tissue in NHS Lothian.

The only difference otherwise in administration is that a protective sleeve automatically covers the needle upon activation

Editorial Information

Last reviewed: 15/10/2025

Next review date: 15/10/2027

Author(s): NHSL Pharmacy Team.

Version: 1

Reviewer name(s): Deepankar Datta.