# A 68-year-old client weighing 75 kg admitted with pneumonia and limited mobility is at moderate risk for VTE. The provider orders enoxaparin 40 mg subcutaneously once daily. The client asks the nurse "Is this dose enough to dissolve a clot if I get one?" Which response is most accurate?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375022&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A 68-year-old client weighing 75 kg admitted with pneumonia and limited mobility is at moderate risk for VTE. The provider orders enoxaparin 40 mg subcutaneously once daily. The client asks the nurse "Is this dose enough to dissolve a clot if I get one?" Which response is most accurate?

## Option

1. Low-molecular-weight heparin like enoxaparin breaks down existing clots by activating plasminogen over a prolonged period. This dose is appropriate for gradually dissolving any clot that may have already formed during your illness.
2. This is the prophylactic (preventive) dose to reduce the risk of forming a new clot during your hospitalization. If a clot were diagnosed, treatment would require a different higher dose — typically about 1 mg/kg every 12 hours or 1.5 mg/kg once daily. **✔ Correct answer**
3. Although enoxaparin is effective for preventing clot formation, this dose will not dissolve an existing clot. For clot dissolution in the legs, the standard approach is oral aspirin therapy, which acts by inhibiting platelets and gradually breaking down the clot.
4. Yes, a 40 mg once-daily dose of enoxaparin is the standard therapeutic regimen for treating deep vein thrombosis or pulmonary embolism. This dose works by binding to antithrombin and inhibiting clotting factors, which helps prevent clot extension and allows the body to dissolve the clot naturally.

**Correct answer: 2**

## Explanation

Prophylactic vs therapeutic LMWH
It is essential to distinguish prevention from treatment dosing because confusing them is a common error and clinical danger:

• Prophylactic enoxaparin: 40 mg SC once daily (or 30 mg q12h in some protocols) — used in hospitalized medical and surgical patients with risk factors for DVT/PE. Lower dose to reduce incidence of new clots.
• Therapeutic enoxaparin: 1 mg/kg SC every 12 hours OR 1.5 mg/kg SC once daily for diagnosed DVT/PE, ACS, or bridging.
• Renal adjust (CrCl

## In-depth explanation

Clinical reasoning summary
Prophylactic vs therapeutic LMWH
It is essential to distinguish prevention from treatment dosing because confusing them is a common error and clinical danger:

• Prophylactic enoxaparin: 40 mg SC once daily (or 30 mg q12h in some protocols) — used in hospitalized medical and surgical patients with risk factors for DVT/PE. Lower dose to reduce incidence of new clots.
• Therapeutic enoxaparin: 1 mg/kg SC every 12 hours OR 1.5 mg/kg SC once daily for diagnosed DVT/PE, ACS, or bridging.
• Renal adjust (CrCl

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