The triple impact of Enoxaparin: Moderating comorbidities, reducing hospitalization, and rationalizing medications

Y. J. Ali; N. B. A. Mohammad; I. M. Faisal; M. M. Merkhan

doi:10.15421/0225156

Y. J. Ali Ninevah Health Directorate
N. B. A. Mohammad Al-Qalam University College
I. M. Faisal University of Mosul
M. M. Merkhan Ninevah Health Directorate

Keywords: Enoxaparin, comorbidity: hospitalization admission, medication profile, anticoagulation, healthcare.

Abstract

Enoxaparin is a low molecular weight heparin which has revealed clinical efficacy through its anticoagulant properties. While it has been thoroughly investigated for coagulation prophylaxis and treatment, its therapeutic role in multiple domains of patient care remain s underexplored. This study sought to evaluate the integrated role of E noxaparin therapy on three healthcare domains: comorbidity management, hospitalization rates, and medication optimization in diverse patient popul a tions. In this prospective observational study, the data were collected directly from patients. A record w as placed for each patient to collect their demographic parameters, Enoxaparin dose, admission date, hospitalization stays and compelling diseases. A total of 125 subjects enrolled in the present study (age 58.2 ± 15.4 years, male 54.4% and females 45.6%). Enoxaparin was used at a daily dose 5280 ± 1147 IU (range 4000 – 8000 IU) with most patients receiving their dose once or twice daily . The m ajority of patients (71.2%) were administered E noxaparin for therapeutic purposes and 28.8% receiv ed prophylactic doses. Gender differences showed non-significant age-related effects ( P = 0.320), with 20 male (16 .0 %) p a tients in the younger group and 29 (23.2%) patients in the older group (>60) , while females were equally matched in each age category. The duration of therapy with E noxaparin demonstrated a non-significant ( P = 0.675) difference between prophylaxis (3.2 ± 2.6 days) and treatment groups (3.4 ± 2.6 days). E noxaparin was mainly indicated for treatment rather than prophylaxis, with the polypharmacy group showing the highest utilization (60.8% for treatment compared to 23.2% for prophylaxis). The d uration of E noxaparin therapy increased non-significantly with polypharmacy severity (2.4 ± 1.5 days in the non-polypharmacy group to 6.3 ± 3.6 days in the hyperpolypharmacy group). The number of medications increased across groups: 3.7 ± 0.5 in non-polypharmacy, 7.6 ± 1.6 in polypharmacy, and 12.2 ± 1.4 in hyperpolypharmacy patients. The hospitalization duration followed similar trends, 2.4 ± 1.5 days in non-polypharmacy patients to 5.8 ± 3.5 days in hyperpolypharmacy patients. The m ajority of patients ha d good outcomes, with the polypharmacy group (99 patients, 79.2%) having the most favourable outcomes . Enoxaparin revealed extensive properties outside its anticoagulant role, pr o viding clear benefits to patient s through comorbidity reduction, hospitalization moderation, and medication optimization. These findings suggest that strategic utilization of E noxaparin may enhance overall healthcare efficiency while improving patient outcomes across multiple therapeutic domains. The triple effects of E noxaparin make it worthy of consideration as a multifaceted therapeutic biomolecule in patient individualized complexity, potentially integrating the care of patients and proper utilization of healthcare resources.

References

AlLehaibi, L. H., Alomar, M., Almulhim, A., Al-Makki, S., Alrwaili, N. R., Al-Bassam, S., Alsultan, S., Al Saeed, J., Alsheef, M., Abraham, I., & Alamer, A. (2023). Effectiveness and safety of Enoxaparin versus unfractionated heparin as thromboprophylaxis in hospitalized COVID-19 patients: Real-world evidence. The Annals of Pharmacotherapy, 57(4), 361–374.

Argenta, C., Ferreira, M. A., Sander, G. B., & Moreira, L. B. (2011). Short-term therapy with Enoxaparin or unfractionated heparin for venous thromboembolism in hospitalized patients: Utilization study and cost-minimization analysis. Value in Health, 14(S1), S89–S92.

Aujesky, D., Smith, K. J., Cornuz, J., & Roberts, M. S. (2005). Cost-effectiveness of low-molecular-weight heparin for treatment of pulmonary embolism. Chest, 128(3), 1601–1610.

Becker, R. C., Mahaffey, K. W., Yang, H., Marian, A. J., Furman, M. I., Michael Lincoff, A., Hazen, S. L., Petersen, J. L., Reist, C. J., Kleiman, N. S., & SYNERGY Investigators (2011). Heparin-associated anti-Xa activity and platelet-derived prothrombotic and proinflammatory biomarkers in moderate to high-risk patients with acute coronary syndrome. Journal of Thrombosis and Thrombolysis, 31(2), 146–153.

Boucher, M., Rodger, M., Johnson, J. A., & Tierney, M. (2003). Shifting from inpatient to outpatient treatment of deep vein thrombosis in a tertiary care center: A cost-minimization analysis. Pharmacotherapy, 23(3), 301–309.

Champion, M. L., Blanchard, C. T., Lu, M. Y., Shea, A. E., Lively, A. I., Jenkins, J. M., Howell, S. E., Lee, G. M., Casey, B. M., Battarbee, A. N., & Subramaniam, A. (2024). A more selective vs a standard risk-stratified, heparin-based, obstetric thromboprophylaxis protocol. JAMA, 332(4), 310–317.

Deitcher, S. R. (2000). Overview of Enoxaparin in the treatment of deep vein thrombosis. The American Journal of Managed Care, 6(20S), S1026–S1033.

Fan, W., Fu, D., Zhang, L., Xiao, Z., Shen, X., Chen, J., & Qi, X. (2023). Enoxaparin sodium bone cement plays an anti-inflammatory immunomodulatory role by inducing the polarization of M2 macrophages. Journal of Orthopaedic Surgery and Research, 18(1), 380.

Fareed, J., Hoppensteadt, D., Walenga, J., Iqbal, O., Ma, Q., Jeske, W., & Sheikh, T. (2003). Pharmacodynamic and pharmacokinetic properties of Enoxaparin: Implications for clinical practice. Clinical Pharmacokinetics, 42(12), 1043–1057.

Ferguson, J. J., Califf, R. M., Antman, E. M., Cohen, M., Grines, C. L., Goodman, S., Kereiakes, D. J., Langer, A., Mahaffey, K. W., Nessel, C. C., Armstrong, P. W., Avezum, A., Aylward, P., Becker, R. C., Biasucci, L., Borzak, S., Col, J., Frey, M. J., Fry, E., Gulba, D. C., … SYNERGY Trial Investigators (2004). Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: Primary results of the SYNERGY randomized trial. JAMA, 292(1), 45–54.

Franconi, F., & Campesi, I. (2017). Sex impact on biomarkers, pharmacokinetics and pharmacodynamics. Current Medicinal Chemistry, 24(24), 2561–2575.

Hakeam, H. A., Al Duhailib, Z., Alsemari, M., Alwaibah, R. M., Al Shannan, M. F., & Shalhoub, M. (2020). Anti-factor Xa levels in low-weight surgical patients receiving Enoxaparin for venous thromboembolism prophylaxis: A prospective cohort study. Clinical and Applied Thrombosis / Hemostasis, 26, 1076029620931194.

Hofmann, T. (2004). Clinical application of Enoxaparin. Expert Review of Cardiovascular Therapy, 2(3), 321–337.

Iqbal, Z., & Cohen, M. (2011). Enoxaparin: A pharmacologic and clinical review. Expert Opinion on Pharmacotherapy, 12(7), 1157–1170.

Jacobson, B., Rambiritch, V., Paek, D., Sayre, T., Naidoo, P., Shan, J., & Leisegang, R. (2020). Safety and efficacy of Enoxaparin in pregnancy: A systematic review and meta-analysis. Advances in Therapy, 37(1), 27–40.

Leri, F., Voyce, S. J., Scialla, S., Glavich, W., Dzielak, E., Smego Jr., R. A., & Guzek, J. (2009). Enoxaparin dosing in the elderly using adjusted body weight. Journal of Thrombosis and Thrombolysis, 28(3), 348–353.

Modi, R. N., Borst, J. M., Kirchberg, T. N., Box, K., Smith, A. M., Godat, L. N., Doucet, J. J., Costantini, T. W., & Berndtson, A. E. (2023). One size does not fit all: Sex bias in pharmacologic venous thromboembolism prophylaxis. The Journal of Trauma and Acute care Surgery, 94(1), 78–85.

Montalescot, G., Bal-dit-Sollier, C., Chibedi, D., Collet, J. P., Soulat, T., Dalby, M., Choussat, R., Cohen, A., Slama, M., Steg, P. G., Dubois-Randé, J. L., Metzger, J. P., Tarragano, F., Guermonprez, J. L., Drouet, L., & ARMADA Investigators (2003). Comparison of effects on markers of blood cell activation of Enoxaparin, dalteparin, and unfractionated heparin in patients with unstable angina pectoris or non-ST-segment elevation acute myocardial infarction (the ARMADA study). The American Journal of Cardiology, 91(8), 925–930.

Mottier, D., Girard, P., Couturaud, F., Lacut, K., Le Moigne, E., Paleiron, N., Guellec, D., Sanchez, O., Cogulet, V., Laporte, S., Marhic, G., Mismetti, P., Presles, E., Robert-Ebadi, H., Mahé, I., Plaisance, L., Reny, J. L., Darbellay Farhoumand, P., Cuvelier, C., Le Henaff, C., … Le Gal, G. (2023). Enoxaparin versus placebo to prevent symptomatic venous thromboembolism in hospitalized older adult medical patients. NEJM Evidence, 2(8), EVIDoa2200332.

Ornstein, D. L., Hong-Dice, Y. G., & Papini, J. R. (2001). Low-molecular-weight heparins for the prevention and treatment of venous thromboembolism. Military Medicine, 166(7), 593–601.

Prithvinathan, V., & Thirunavikkarasu, R. (2025). Coagulation dynamics in laparoscopic cholecystectomy: Investigating the impact of carbon dioxide pneumoperitoneum. Texila International Journal of Public Health, 13(1), 81.

Saithong, S., Saisorn, W., Tovichayathamrong, P., Filbertine, G., Torvorapanit, P., Wright, H. L., Edwards, S. W., Leelahavanichkul, A., Hirankarn, N., & Chiewchengchol, D. (2022). Anti-inflammatory effects and decreased formation of neutrophil extracellular traps by Enoxaparin in COVID-19 patients. International Journal of Molecular Sciences, 23(9), 4805.

Shastri, M. D., Stewart, N., Horne, J., Zaidi, S. T., Sohal, S. S., Peterson, G. M., Korner, H., Gueven, N., & Patel, R. P. (2015). Non-anticoagulant fractions of Enoxaparin suppress inflammatory cytokine release from peripheral blood mononuclear cells of allergic asthmatic individuals. PloS One, 10(6), e0128803.

Siddiqui, M. A., & Wagstaff, A. J. (2005). Enoxaparin: A review of its use as thromboprophylaxis in acutely ill, nonsurgical patients. Drugs, 65(7), 1025–1036.

Spyropoulos, A. C., Hurley, J. S., Ciesla, G. N., & de Lissovoy, G. (2002). Management of acute proximal deep vein thrombosis: Pharmacoeconomic evaluation of outpatient treatment with Enoxaparin vs inpatient treatment with unfractionated heparin. Chest, 122(1), 108–114.

Tinchon, A., Brait, J., Klee, S., Graichen, U., Baumgartner, C., Friedrich, O., Freydl, E., Oberndorfer, S., Struhal, W., Hain, B., Waiß, C., & Stoiber, D. (2024). How Enoxaparin underdosing and sex contribute to achieving therapeutic anti-Xa levels. Frontiers in Pharmacology, 15, 1377232.

Triscott, J., Mercer, S., Tian, P. G., & Dobbs, B. (2015). Retroperitoneal haematoma associated with Enoxaparin use in an elderly woman with chronic kidney disease. BMJ Case Reports, 2015, bcr2015211699.

Xie, K., Yang, H., Wang, S., Xiao, C., Lan, T., Jiang, H., Li, S., Tu, H., Yang, J., Lyv, T., Qiu, J., Zhou, J., Zhang, Z., Du, C., Wu, X., Huang, J., Elgendi, A. M., Kow, A. W. C., Yang, J., Zeng, Y., … Wu, H. (2025). Comparing the efficacy and safety of thromboprophylaxis with Enoxaparin versus normal saline after liver transplantation: Randomized clinical trial. The British Journal of Surgery, 112(2), znae325.