The aim of this study was to compare an individualized dosing regimen for enoxaparin to conventional dosing. Patients in the individualized arm were initially dosed according to weight: patients <100 kg using total body weight; patients ≥100 kg using lean body weight. Doses were adjusted at 48 h according to renal function. Patients in the conventional arm received enoxaparin according to current practice. Dose-individualized patients had fewer bleeding events (primary end point; relative risk (RR)=0.12, 95% confidence interval (CI)=0.01-0.89, P=0.03) and composite bleeding and bruising events (secondary end point; RR=0.30, 95% CI=0.12-0.71, P=0.003) than those who received conventional dosing. In both arms of the study, there were no recurrent thromboembolic events during treatment and no deaths had occurred at 30 days. Dose individualization of enoxaparin significantly reduces the prevalence of bleeding and bruising events, without apparent loss in effectiveness.