From bench to bedside: the untold story behind the clinical development of enoxaparin

The path to the development of enoxaparin (Lovenox/Clexane), one of the most widely used low-molecular-weight heparins worldwide, was far from smooth. This narrative review, presented from the personal perspective of the senior author who lived this journey, describes the pivotal research conducted at McMaster University in Canada that transformed enoxaparin from a promising laboratory compound into a cornerstone of prevention and treatment of thrombosis. The story begins in the late 1970s with the observation that low-molecular-weight heparin, produced through controlled depolymerization, exhibited antithrombotic efficacy comparable with unfractionated heparin, with a reduced risk of bleeding in animal models. It concludes in the 1990s with the successful evaluation in clinical trials and the regulatory approval of enoxaparin for the prevention of deep vein thrombosis after orthopedic surgery.