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Venous thromboembolism (VTE) treatment - enoxaparin dosing in renal impairment

  • For patients with creatinine clearance (CrCl) 15-29ml/minute, the recommended enoxaparin dose is 1mg/kg once daily regardless of thrombosis risk - see table 4 below.
  • Enoxaparin is not licensed in CrCl <15ml/minute. See the GGC guideline for advice in significant renal impairment.
  • If the patient has a standard risk of thrombosis and CrCl ≥30ml/minute- see table 2 for dosing advice.
  • If the patient has a high risk of thrombosis and CrCl ≥30ml/minute- see table 3 for dosing advice.

Table 4 – Enoxaparin renal dosing in VTE treatment

Actual weight (kg) Enoxaparin renal dose 1mg/kg once daily
35–44 40mg once daily*
45–66 60mg once daily
67-88 80mg once daily
89-110 100mg once daily
>110 120mg once daily

NOTES

  • *To reduce the risk of confusion of 40mg enoxaparin treatment doses with prophylactic doses, document clearly in the notes and consider adding a note on HEPMA to highlight the indication.
  • If CrCl <30ml/minute, or very low or high body weight (e.g. <35kg or >120kg), consider assessing anti-factor Xa activity after 3 consecutive doses to check dose is therapeutic, and after 8-10 doses to check for accumulation. The level should be taken 4 hours post-dose with a target of 0.5-1.2units/ml.
  • Guidance on heparin dose adjustment for patients with significant renal impairment or with high or low body weight is available on the Clinical Guideline Platform.

Guideline reviewed: July 2026

Page updated: July 2026