Background: Potential limitations of unfractionated heparin (UFH) have prompted a search for new antithrombin therapies in recent years. Enoxaparin has shown similar or improved efficacy when compared with UFH, but it has been associated with safety concerns of increased bleeding in patients with acute coronary syndromes in some studies.
Objective: This narrative review focuses on the safety and tolerability of enoxaparin in adult patients in the setting of currently approved indications.
Methods: Synthesis of evidence from recent trials, systematic reviews, meta-analyses, regulatory documents and clinical trials registries of manufacturers.
Conclusion: Enoxaparin can be considered for prophylaxis and treatment of a wide range of thrombotic conditions as an alternative to UFH with a clinically modest increase in bleeding complications, without altering the risk-benefit profile of this compound. Selection of the appropriate dosage is strongly recommended. Special precautions should be taken in specific populations that are at higher risk of bleeding, such as patients with renal dysfunction and elderly patients, where dose adjustment is recommended.