Extended-Release Enoxaparin
Mechanism of Action
Inhibits Factor Xa and thrombin via antithrombin III. More predictable pharmacokinetics than unfractionated heparin.
Indications
Extended-Release 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 Extended-Release 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).