Pregnant Patients

1. Both unfractionated heparin and enoxaparin are considered safe in pregnancy as neither crosses the placenta. 49-51

2. Pregnant trauma patients should receive an initial dose of 30 mg of enoxaparin twice daily titrated by anti-Xa levels, (if available) targeting a peak range of 0.2 to 0.4 IU/mL or a trough range of 0.1 to 0.2 IU/mL.

Pregnancy increases renal clearance, leads to changes in weight, and induces hormonal changes that result in hypercoagulability. All these factors influence drug dosing for chemoprophylaxis.

3. For pregnant trauma patients who weigh more than 90 kg, initiating 40 mg of enoxaparin twice daily is recommended with similar anti-Xa level titration.