Enoxaparin (LMWH)

• VTE prophylaxis in pregnancy & puerperium
• Treatment of DVT/PE in pregnancy
• Recurrent miscarriage with antiphospholipid syndrome (with aspirin)

Binds antithrombin → preferential inhibition of factor Xa (and less IIa) → ↓ thrombin generation.

• Predictable PK — no APTT monitoring
• Excretion renal — beware CrCl <30
• Antidote partial — protamine
• Reversal: 1 mg per 1 mg enoxaparin (≤8 h)
• Stop 24 h before delivery/regional

Prophylaxis (booking weight)

<50 kg 20 mg OD; 50–90 kg 40 mg OD; 91–130 kg 60 mg OD

Treatment

1 mg/kg BD (or 1.5 mg/kg OD)

Pre-delivery

Omit ≥24 h before planned IOL/CS or regional

• AbsoluteActive major bleeding
• AbsoluteKnown HIT (heparin-induced thrombocytopenia)
• CautionSevere renal impairment — reduce dose / monitor anti-Xa

• Injection-site bruising
• Bleeding
• HIT (rare)
• Osteoporosis (long-term, less than UFH)

• • Does NOT cross placenta — safe for fetus.
• • Safe in breastfeeding (not absorbed orally).

• NSAIDs / antiplatelets

  Caution

  ↑ bleeding risk

• Regional anaesthesia

  Avoid

  Wait ≥24 h (treatment) or ≥12 h (prophylaxis)

• 💡 Restart 6–12 h post-vaginal birth, 12 h post-CS.
• 💡 Continue ≥6 wks postpartum if VTE treatment.