Combination Enoxaparin
Mechanism of Action
Inhibits Factor Xa and thrombin via antithrombin III. More predictable pharmacokinetics than unfractionated heparin.
Indications
Combination formulation. DVT treatment and prophylaxis, pulmonary embolism, acute coronary syndromes. High-priority medication for lunar medical bay given elevated thrombosis risk in residents.
Dosing
Standard (Earth)
See Combination prescribing information. Treatment: 1 mg/kg SC every 12 hours. Prophylaxis: 40 mg SC once daily.
Lunar Protocol
Weight-based dosing unchanged. Monitor anti-Xa levels if renal function impaired. SC injection technique: in 1/6g, subcutaneous tissue may have altered perfusion — abdominal injection preferred over thigh for more consistent absorption. Storage quality monitoring critical — degraded LMWH may be less effective without visual indication.
Storage
Standard
Refrigerated (2-8°C) or room temperature up to 25°C for 1 month.
Lunar (Radiation + Temperature)
Maintain cold chain (habitat refrigerator). Radiation shielding critical — ionizing radiation degrades LMWH. Monitor storage temperature continuously with alarm. 6-month supply minimum. Emergency plan for refrigeration failure (move to shielded room-temperature storage; maximum 1-month effective use).
Supply Chain & Lunar Pharmacy Notes
Requires cold chain. High priority for resupply planning. Biological product requiring careful handling. Single-dose pre-filled syringes preferred for lunar use — reduce dosing errors and infection risk.
Drug Interactions
Aspirin, NSAIDs, other anticoagulants, SSRIs (increased bleeding risk).
Contraindications
Active bleeding, heparin-induced thrombocytopenia, severe renal failure (dose adjust).
Side Effects
Bleeding, thrombocytopenia (HIT), injection site reactions.
Lunar Alternatives
Unfractionated heparin (if anti-Xa monitoring unavailable), rivaroxaban (oral, no monitoring but less reversal options).