VTE Prophylaxis
Standardized enoxaparin dosing based on age, weight, and renal function.
Updated: 02/20/2025
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💊Standard Dosing
▼| Patient | Dose |
|---|---|
| Age ≤65, ≥50kg, CrCl >60 | Enoxaparin 40mg Q12h |
| Age >65, <50kg, CrCl 30–60, TBI, or SCI | Enoxaparin 30mg Q12h |
| CrCl <30 or Cr rise >50% | Heparin 5000U Q8h |
⚙️Special Populations
▼1
Operative Ortho
Hold morning dose day of surgery. Give post-op night of surgery.
2
Lower Extremity Ortho
Enoxaparin inpatient. Discharge: ASA 81mg BID ×30 days.
3
TBI Minor (GCS 15, BIG 1)
Enoxaparin 30mg BID preferred.
4
TBI Moderate/Severe (BIG 2–3)
Defer to neurosurgery.
5
SCI
Within 24h. Enoxaparin 30mg BID unless modified by NSGY.
6
Epidural Catheter
NO enoxaparin 12h before/during/24h after removal. Use Heparin 5000U Q8h + SCDs.
7
High-Grade Solid Organ Injury
Should not hold >72h if no active bleed or hemodynamic instability.
Enoxaparin 40mg SQ Q12h
[Age >65, wt <50kg, CrCl 30–60, TBI, SCI: use 30mg Q12h]
[CrCl <30 or Cr rise >50%: Heparin 5000U SQ Q8h]
- Status
- AHS Official Protocol
- Source
- VTE_PPX.docx
- Last reviewed / updated
- 02/20/2025