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Pathway Description
Enoxaparin.
Homo sapiens
Drug Action Pathway
Enoxaparin is a low molecular weight heparin used to reduce cardiovascular events. Enoxaparin's action is antithrombin-dependent. The drug binds to antithrombin III to reduce thrombin inhibition in the plasma. The drug increases the inactivation of coagulation factors IXa, Xa and XIIa. This increases the antithrombin effects. Compared to unfractionated heparin, low molecular weight heparins have lower affinity for plasma proteins and therefore only few are protein bound. They also are not inactivated by platelet factor 4 and does not bind endothelial cells or macrophages thus are not degraded as fast. Therefore, low molecular weight heparins like Enoxaparin are more stable and predictable heparins.
References
Enoxaparin. References
Jennings LK, Saucedo JF: Antiplatelet and anticoagulant agents: key differences in mechanisms of action, clinical application, and therapeutic benefit in patients with non-ST-segment-elevation acute coronary syndromes. Curr Opin Cardiol. 2008 Jul;23(4):302-8. doi: 10.1097/HCO.0b013e3283021ad9.
Pubmed: 18520712
Lovenox. (2009). e-CPS (online version of Compendium of Pharmaceuticals and Specialties). Retrieved June 26, 2009.
Walker CP, Royston D: Thrombin generation and its inhibition: a review of the scientific basis and mechanism of action of anticoagulant therapies. Br J Anaesth. 2002 Jun;88(6):848-63. doi: 10.1093/bja/88.6.848.
Pubmed: 12173205
Buckmaster ND, Heazlewood V, Scott IA, Jones M, Haerer W, Hillier K: Using a clinical pathway and education to reduce inappropriate prescribing of enoxaparin in patients with acute coronary syndromes: a controlled study. Intern Med J. 2006 Jan;36(1):12-8. doi: 10.1111/j.1445-5994.2005.00989.x.
Pubmed: 16409308
He Z, Morrissey H, Ball P: Review of current evidence available for guiding optimal Enoxaparin prophylactic dosing strategies in obese patients-Actual Weight-based vs Fixed. Crit Rev Oncol Hematol. 2017 May;113:191-194. doi: 10.1016/j.critrevonc.2017.03.022. Epub 2017 Mar 22.
Pubmed: 28427508
Coagulation References
van der Meijden PE, Munnix IC, Auger JM, Govers-Riemslag JW, Cosemans JM, Kuijpers MJ, Spronk HM, Watson SP, Renne T, Heemskerk JW: Dual role of collagen in factor XII-dependent thrombus formation. Blood. 2009 Jul 23;114(4):881-90. doi: 10.1182/blood-2008-07-171066. Epub 2009 Apr 16.
Pubmed: 19372258
Norris LA: Blood coagulation. Best Pract Res Clin Obstet Gynaecol. 2003 Jun;17(3):369-83.
Pubmed: 12787532
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