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Enoxaparin side effects: what 57,199 FDA adverse event reports show

Enoxaparin Sodium · 1,269 reaction terms · 211,286 drug–reaction co-reports · data 2026-09-14
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Drug class

Low molecular weight heparin (lmwh)

FDA label, Indications wording of the closest related product

Label matched

Enoxaparin Sodium (Enoxaparin Sodium)

closest FDA label found for this product string; brand list suppressed because the label is a related product, not an exact match

Who reports

57,199 reports · 87% serious · 8,879 with death outcome · 53% female

openFDA FAERS counts, all years, deduplication not applied

Used for

Enoxaparin Sodium Injection is a low molecular weight heparin (LMWH) indicated for: Prophylaxis of deep vein thrombosis (DVT) in abdominal surgery, hip replacement surgery, knee replacement surgery, or medical patients with severely restricted mobility.

FDA label, Indications and Usage

What it is

Enoxaparin Sodium Injection, USP is a sterile aqueous solution containing enoxaparin sodium, a low molecular weight heparin. The pH of the injection is 5.5 to 7.5. Enoxaparin sodium is obtained by alkaline depolymerization of heparin benzyl ester derived from porcine intestinal mucosa.

FDA label, Description section

Boxed warning

SPINAL/EPIDURAL HEMATOMAS Epidural or spinal hematomas may occur in patients who are anticoagulated with low molecular weight heparins (LMWH) or heparinoids and are receiving neuraxial anesthesia or undergoing spinal puncture. These hematomas may result in long-term or permanent paralysis. Consider these risks when scheduling patients for spinal procedures.

FDA label
How to read this page. FAERS is a spontaneous-reporting system: counts are not incidence rates and a signal is not proof of causation. Each reaction below is run through an automated screen — is the term in the FDA label (known), in the indications (the disease being treated), an administrative/coding term, or none of these (unlabeled)? That screen is mechanical text matching, not a causality assessment. The 30 hand-written Bradford Hill assessments are on the causality assessment page. Not medical advice.

Causality screen of the 40 strongest signals

Labeled — boxed warning 2Labeled adverse reaction 2Labeled (related wording) 11Reporting / coding artifact 2Lab value / disease marker 1Not in label — unassessed 22
What the badges mean

Strongest disproportionality signals

Flagged terms (PRR ≥ 2, χ² ≥ 4, n ≥ 10), ranked by PRR; infinite PRRs (no comparator reports) excluded. The EBGM column is a second, shrinkage-based estimate (MGPS) with its 5th percentile EB05 and the BCPNN IC025; a pair flagged by PRR alone is marked PRR-only and should be read as fragile. The strata column recomputes the PRR on serious reports only (and, for the 300 most-reported drugs, adjusted for age band), and flags pairs whose reports are unusually skewed by sex or come mostly from consumers. Each row also shows the PRR against the other drugs of the same FDA class, which removes most confounding by the condition being treated, and a calibrated p-value: on validation, known non-causes average an ROR of about 2, so significance is judged against that empirical null (✓ = p < 0.05 after calibration). 1,229 further terms are in the interactive explorer. Reaction links open the term's cross-drug page.

Show:
ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Truncus arteriosus persistent4193.6
66.4–132.0ROR 93.7 · calibrated p 4e-7 ✓
72.1 EB05 55.4 · IC025 +4.8
3/3 methods agree
Not in label — unassessedserious n=41 · 100% cliniciannot reported in cached trials
Amaurosis fugax21391.2
78.4–105.9ROR 91.5 · calibrated p 3e-7 ✓
72.5 EB05 64.7 · IC025 +5.7
3/3 methods agree
Not in label — unassessedserious n=213 · 94% cliniciannot reported in cached trials
Pelvic haematoma7070.1
54.3–90.6ROR 70.2 · calibrated p 2e-6 ✓
58.0 EB05 47.5 · IC025 +5.0
3/3 methods agree
Not in label — unassessedserious n=70 · ♀ 100% (drug 53%) · 100% cliniciannot reported in cached trials
Haematoma muscle15957.2
48.4–67.6ROR 57.3 · calibrated p 6e-6 ✓
49.2 EB05 43.1 · IC025 +5.2
3/3 methods agree
Not in label — unassessedserious n=158 · 100% cliniciannot reported in cached trials
Heparin-induced thrombocytopenia63754.1
49.8–58.8ROR 54.7 · calibrated p 8e-6 ✓
47.1 EB05 44.1 · IC025 +5.4
3/3 methods agree
Labeled — boxed warning
exact term
serious n=626 · 95% clinicianNCT00571649: 1/4,001 (0.0%) on Enoxaparin (serious AE)
Device safety feature issue11851.6
42.6–62.6ROR 51.7 · calibrated p 1e-5 ✓
45.0 EB05 38.6 · IC025 +4.9
3/3 methods agree
Reporting / coding artifact♀ 100% (drug 53%)not reported in cached trials
Intra-abdominal haematoma15351.4
43.4–60.9ROR 51.5 · calibrated p 1e-5 ✓
44.9 EB05 39.2 · IC025 +5.0
3/3 methods agree
Not in label — unassessedserious n=153NCT01583218: 1/3,716 (0.0%) on Enoxaparin (serious AE)
Thrombocythaemia6346.5
35.8–60.4ROR 46.5 · calibrated p 3e-5 ✓
40.8 EB05 33.0 · IC025 +4.6
3/3 methods agree
Not in label — unassessedserious n=59 · 100% cliniciannot reported in cached trials
Mixed liver injury20527.7
24.1–31.9ROR 27.8 · calibrated p 4e-4 ✓
25.8 EB05 22.9 · IC025 +4.4
3/3 methods agree
Not in label — unassessedserious n=205 · 100% cliniciannot reported in cached trials
Muscle haemorrhage26826.2
23.2–29.7ROR 26.3 · calibrated p 5e-4 ✓
24.5 EB05 22.1 · IC025 +4.4
3/3 methods agree
Not in label — unassessedserious n=264NCT00571649: 1/4,001 (0.0%) on Enoxaparin (serious AE)
Cardiac septal defect4121.9
16.0–30.1ROR 22.0 · calibrated p 0.002 ✓
20.6 EB05 15.8 · IC025 +3.5
3/3 methods agree
Not in label — unassessedserious n=41 · 100% cliniciannot reported in cached trials
Extradural haematoma7321.3
16.8–26.9ROR 21.3 · calibrated p 0.002 ✓
20.0 EB05 16.5 · IC025 +3.8
3/3 methods agree
Not in label — unassessedserious n=72 · 100% cliniciannot reported in cached trials
Haemorrhagic stroke40519.9
18.0–22.0ROR 20.0 · calibrated p 0.002 ✓
18.9 EB05 17.4 · IC025 +4.0
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 12.5NCT00571649: 1/3,997 (0.0%) on Enoxaparin (serious AE)
Hepatic cytolysis62819.8
18.3–21.5ROR 20.0 · calibrated p 0.002 ✓
18.8 EB05 17.6 · IC025 +4.1
3/3 methods agree
Not in label — unassessedserious PRR 12.5 · 97% cliniciannot reported in cached trials
International normalised ratio decreased20419.2
16.7–22.1ROR 19.3 · calibrated p 0.002 ✓
18.3 EB05 16.3 · IC025 +3.9
3/3 methods agree
Lab value / disease markerserious n=151not reported in cached trials
Congenital cardiovascular anomaly3917.6
12.8–24.3ROR 17.6 · calibrated p 0.004 ✓
16.6 EB05 12.6 · IC025 +3.3
3/3 methods agree
Not in label — unassessedserious n=39 · 100% cliniciannot reported in cached trials
Acute generalised exanthematous pustulosis35017.3
15.6–19.3ROR 17.4 · calibrated p 0.004 ✓
16.6 EB05 15.2 · IC025 +3.8
3/3 methods agree
Not in label — unassessedserious PRR 11.0 · 93% clinicianNCT01583218: 1/3,716 (0.0%) on Enoxaparin (serious AE)
Streptococcal sepsis5116.3
12.3–21.6ROR 16.3 · calibrated p 0.006 ✓
15.5 EB05 12.2 · IC025 +3.3
3/3 methods agree
Not in label — unassessedserious n=51 · ♀ 100% (drug 53%)not reported in cached trials
Haematoma1,10916.3
15.3–17.3ROR 16.6 · calibrated p 0.005 ✓
15.6 EB05 14.9 · IC025 +3.9
3/3 methods agree
Labeled — boxed warning
exact term
serious PRR 10.8NCT00571649: 1/4,001 (0.0%) on Enoxaparin (serious AE)
Post procedural haematoma7216.2
12.8–20.5ROR 16.2 · calibrated p 0.006 ✓
15.5 EB05 12.6 · IC025 +3.4
3/3 methods agree
Reporting / coding artifactserious n=70 · 100% cliniciannot reported in cached trials
Urinary tract disorder18916.0
13.9–18.6ROR 16.1 · calibrated p 0.005 ✓
15.4 EB05 13.6 · IC025 +3.7
3/3 methods agree
Not in label — unassessedserious n=187 · 94% clinicianNCT00571649: 13/4,001 (0.3%) on Enoxaparin (serious AE)
Intra-abdominal haemorrhage9715.5
12.6–19.0ROR 15.5 · calibrated p 0.007 ✓
14.8 EB05 12.5 · IC025 +3.5
3/3 methods agree
Not in label — unassessedserious n=97not reported in cached trials
Cholestasis (bile flow blockage)76715.3
14.2–16.4ROR 15.5 · calibrated p 0.006 ✓
14.7 EB05 13.9 · IC025 +3.7
3/3 methods agree
Not in label — unassessedserious PRR 9.8 · 95% clinicianNCT00571649: 2/3,997 (0.1%) on Enoxaparin (serious AE)
Vascular pseudoaneurysm6714.6
11.4–18.6ROR 14.6 · calibrated p 0.009 ✓
13.9 EB05 11.3 · IC025 +3.3
3/3 methods agree
Not in label — unassessedserious n=65 · 100% cliniciannot reported in cached trials
Rash morbilliform10614.5
12.0–17.6ROR 14.6 · calibrated p 0.008 ✓
13.9 EB05 11.8 · IC025 +3.4
3/3 methods agree
Not in label — unassessedserious n=104 · 100% cliniciannot reported in cached trials
Jugular vein thrombosis6313.5
10.5–17.4ROR 13.6 · calibrated p 0.012 ✓
12.9 EB05 10.4 · IC025 +3.2
3/3 methods agree
Not in label — unassessedserious n=59not reported in cached trials
Eosinophilia62113.5
12.4–14.6ROR 13.6 · calibrated p 0.010 ✓
13.0 EB05 12.2 · IC025 +3.6
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 9.0 · 95% cliniciannot reported in cached trials
Cytolytic hepatitis11913.4
11.2–16.1ROR 13.4 · calibrated p 0.012 ✓
12.9 EB05 11.0 · IC025 +3.3
3/3 methods agree
Not in label — unassessedserious n=118NCT00571649: 1/4,001 (0.0%) on Enoxaparin (serious AE)
Hypercoagulation6713.3
10.4–16.9ROR 13.3 · calibrated p 0.013 ✓
12.7 EB05 10.2 · IC025 +3.2
3/3 methods agree
Not in label — unassessedserious n=63not reported in cached trials

Trial evidence (ClinicalTrials.gov)

✓ Trial adverse-event data found on ClinicalTrials.gov

Largest completed trials with posted results that list Enoxaparin as a study intervention. The right-hand column of the signal table shows whether each FAERS term was also recorded in these trials, with a real denominator (17 of 40 signal terms matched).

Caveats: trial populations, doses and follow-up differ from the reporting population; AE terms are sponsor-coded and matched here by wording; absence from a trial list means the term was not reported above the sponsor's frequency threshold, not that it cannot occur.

Most frequently reported reactions

By raw co-report count, regardless of disproportionality. Common terms here are often the illness itself or generic outcomes.

ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Off label use (used outside approved label)2,5661.1
1.0–1.1ROR 1.1 · calibrated p 0.365
1.1 EB05 1.0 · IC025 +0.1Reporting / coding artifactserious PRR 0.9not reported in cached trials
Dyspnoea (shortness of breath)2,4291.6
1.5–1.6ROR 1.6 · calibrated p 0.708
1.6 EB05 1.5 · IC025 +0.6Labeled adverse reaction
exact term
serious PRR 1.4NCT00571649: 17/4,001 (0.4%) on Enoxaparin (serious AE)
Nausea2,4201.1
1.1–1.2ROR 1.1 · calibrated p 0.393
1.1 EB05 1.1 · IC025 +0.1Labeled adverse reaction
exact term
serious PRR 1.3NCT00571649: 5/4,001 (0.1%) on Enoxaparin (serious AE)
Diarrhoea (diarrhea)2,3041.3
1.3–1.4ROR 1.3 · calibrated p 0.527
1.3 EB05 1.3 · IC025 +0.3Labeled adverse reaction
exact term
serious PRR 1.4NCT00571649: 10/4,001 (0.2%) on Enoxaparin (serious AE)
Anaemia (low red blood cells)2,2334.3
4.2–4.5ROR 4.5 · calibrated p 0.302
4.3 EB05 4.1 · IC025 +2.0
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 3.1NCT00571649: 13/4,001 (0.3%) on Enoxaparin (serious AE)
Thrombocytopenia (low platelets)2,1067.0
6.7–7.3ROR 7.3 · calibrated p 0.089
6.9 EB05 6.7 · IC025 +2.7
3/3 methods agree
Labeled — boxed warning
exact term
serious PRR 4.7NCT00571649: 9/4,001 (0.2%) on Enoxaparin (serious AE)
Fatigue (tiredness)2,0151.0
0.9–1.0ROR 0.9 · calibrated p 0.274
1.0 EB05 0.9 · IC025 -0.1
PRR-only: not supported by EBGM or IC
Not in label — unassessedserious PRR 1.0NCT00571649: 3/4,001 (0.1%) on Enoxaparin (serious AE)
Vomiting1,8921.5
1.4–1.5ROR 1.5 · calibrated p 0.640
1.5 EB05 1.4 · IC025 +0.5Not in label — unassessedserious PRR 1.4NCT00571649: 4/4,001 (0.1%) on Enoxaparin (serious AE)
Pulmonary embolism (lung blood clot)1,8097.1
6.7–7.4ROR 7.3 · calibrated p 0.089
6.9 EB05 6.7 · IC025 +2.7
3/3 methods agree
Likely indication confounding
term in indications; also in warnings
serious PRR 4.6NCT00571649: 4/4,001 (0.1%) on Enoxaparin (serious AE)
Death1,7610.7
0.7–0.8ROR 0.7 · calibrated p 0.152
0.7 EB05 0.7 · IC025 -0.5
PRR-only: not supported by EBGM or IC
Outcome field, not a reactionserious PRR 0.5NCT00571649: 9/4,001 (0.2%) on Enoxaparin (serious AE)
Pneumonia (lung infection)1,6941.9
1.8–2.0ROR 2.0 · calibrated p 0.919
1.9 EB05 1.8 · IC025 +0.9Labeled adverse reaction
exact term
serious PRR 1.3NCT00571649: 10/4,001 (0.2%) on Enoxaparin (serious AE)
Asthenia (weakness)1,6291.6
1.5–1.7ROR 1.6 · calibrated p 0.711
1.6 EB05 1.5 · IC025 +0.6Not in label — unassessedserious PRR 1.4NCT00571649: 1/4,001 (0.0%) on Enoxaparin (serious AE)
Acute kidney injury (sudden kidney damage)1,6003.9
3.7–4.1ROR 4.0 · calibrated p 0.384
3.8 EB05 3.7 · IC025 +1.9
3/3 methods agree
Not in label — unassessedserious PRR 2.5 · 90% cliniciannot reported in cached trials
Fall1,5401.7
1.6–1.8ROR 1.7 · calibrated p 0.782
1.7 EB05 1.6 · IC025 +0.7Labeled adverse reaction
exact term
serious PRR 1.3NCT00571649: 3/4,001 (0.1%) on Enoxaparin (serious AE)

Unlabeled candidate signals

These flagged terms were not found in the FDA label text and do not match an artifact pattern. They are the pairs that would merit a structured assessment (temporality, dose-response, biological plausibility, consistency across databases, trial or cohort evidence). The screen has not done that; string-matching misses label wording, and a strong PRR can still be stimulated reporting, co-medication, or the disease itself.

✓ A hand-written Bradford Hill causality assessment exists for this drug: Enoxaparin (low-molecular-weight heparins) ↔ Heparin-induced thrombocytopenia (HIT).

Want to assess one of these properly? The runbook describes the Bradford Hill / trial-evidence workflow used on the assessment page, and handoff_top1000_signals.csv lists the strongest unassessed pairs across all drugs.

Common questions

What are the most reported side effects of Enoxaparin?

In FDA FAERS, the most frequently co-reported reaction terms for Enoxaparin are dyspnoea, nausea, diarrhoea, anaemia, thrombocytopenia, pyrexia. These are report counts, not rates: FAERS has no denominator, reporting is voluntary and uneven, and a term can be reported because of the illness being treated rather than the drug.

Does Enoxaparin have an FDA boxed warning?

Yes. The current FDA label carries a boxed warning: SPINAL/EPIDURAL HEMATOMAS Epidural or spinal hematomas may occur in patients who are anticoagulated with low molecular weight heparins (LMWH) or heparinoids and are receiving neuraxial anesthesia or undergoing spinal puncture. These hematomas may result in long-term or permanent paralysis. Consider these risks when scheduling patients for spinal procedures.

Do FAERS signals prove that Enoxaparin causes these side effects?

No. A disproportionality signal (PRR, ROR) means a reaction is reported more often with this drug than with others in the database. That can reflect a real effect, but also the disease being treated, stimulated reporting after news or litigation, co-medications, or how reports are coded. Causality needs temporality, dose-response, biological plausibility, consistency across data sources and, ideally, trial or cohort evidence. This page screens each term against the FDA label and ClinicalTrials.gov results; it does not establish causation.

Sources & methods

Page generated 2026-10-14. Label and PubChem text are retrieved automatically and may lag the current label; always check the current prescribing information. OpenPV is a beta research tool of the Open Source Medicine Foundation.