Last reviewed 2026-04-22 · How we verify

Enoxaparin followed by VKA

Enoxaparin is a low-molecular-weight heparin that inhibits blood clotting factors, followed by a vitamin K antagonist (VKA) to maintain long-term anticoagulation.

Enoxaparin is a low-molecular-weight heparin that inhibits blood clotting factors, followed by a vitamin K antagonist (VKA) to maintain long-term anticoagulation. Used for Venous thromboembolism (DVT/PE) treatment and prevention, Acute coronary syndrome, Atrial fibrillation for stroke prevention.

At a glance

Mechanism of action

Enoxaparin works by potentiating antithrombin III to inhibit factors Xa and IIa, preventing thrombus formation. After initial parenteral anticoagulation with enoxaparin, a VKA (such as warfarin) is initiated to provide sustained oral anticoagulation by inhibiting vitamin K-dependent clotting factors (II, VII, IX, X). This sequential approach bridges acute anticoagulation with long-term oral therapy.

Approved indications

• Venous thromboembolism (DVT/PE) treatment and prevention
• Acute coronary syndrome
• Atrial fibrillation for stroke prevention

Common side effects

• Bleeding
• Thrombocytopenia
• Injection site reactions (enoxaparin)
• Elevated liver enzymes
• Skin necrosis (VKA)

Key clinical trials

• Edoxaban vs. Warfarin in Subjects Undergoing Cardioversion of Nonvalvular Atrial Fibrillation (NVAF) (PHASE3)
• XENITH: Rivaroxaban for Pulmonary Embolism Managed With Catheter Directed Thrombolysis (PHASE4)
• Oral Direct Factor Xa Inhibitor Rivaroxaban in Patients With Acute Symptomatic Deep Vein Thrombosis - The EINSTEIN DVT Study (PHASE3)
• Oral Direct Factor Xa Inhibitor Rivaroxaban in Patients With Acute Symptomatic Pulmonary Embolism - The EINSTEIN PE Study (PHASE3)

Primary sources

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