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(eh-NOX-uh-par-in SO-dee-uhm)
Lovenox
Class: Anticoagulant

 Action Causes higher anti-factor Xa to antithrombin activities (anti-factor IIa) ratio than heparin, which may prevent thrombosis.

 Indications Prevention of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE) in patients undergoing hip or knee replacement surgery or abdominal surgery; in conjunction with warfarin sodium for inpatient treatment of acute DVT with and without PE or outpatient treatment of acute DVT without PE; prevention of ischemic complications of unstable and non-Q-wave MI when coadministered with aspirin. Unlabeled use(s): Systemic anticoagulation; secondary prophylaxis for thromboembolic recurrence.

 Contraindications Hypersensitivity to enoxaparin, heparin, or pork products; active major bleeding; thrombocytopenia associated with positive in vitro test for antiplatelet antibody in presence of enoxaparin.

 Route/Dosage

Hip or Knee Replacement Surgery

ADULTS: SC 30 mg bid, with initial dose given within 12 to 24 hours postoperatively, provided hemostasis has been established. Average duration of administration is 7 to 10 days. For hip replacement surgery, 40 mg once daily, given initially 9 to 15 hours prior to surgery; continue prophylaxis for 3 weeks.

Abdominal Surgery

ADULTS: SC 40 mg/day with the initial dose given 2 hours prior to surgery. Usual duration of administration is 7 to 10 days; up to 12 days.

DVT/PE, Treatment

OUTPATIENT: SC 1 mg/kg q 12 hours. INPATIENT: SC 1 mg/kg q 12 hours or 1.5 mg/kg once daily (same time each day). OUTPATIENT AND INPATIENT: Initiate warfarin therapy when appropriate (usually within 72 hours of enoxaparin). Continue enoxaparin for a minimum of 5 days and until a therapeutic anticoagulant effect has been achieved. The average duration is 7 days; up to 17 days has been well tolerated.

Unstable Angina/Non-Q-Wave MI

ADULTS: SC 1 mg/kg q 12 hours in conjunction with oral aspirin therapy (100 to 325 mg once daily); usual duration of treatment is 2 to 8 days.

Thromboembolic Recurrence/Prophylaxis

ADULTS: SC 40 mg once daily.

 Interactions

Anticoagulants, NSAIDs, platelet inhibitors: Use enoxaparin with care. INCOMPATIBILITIES: Do not mix enoxaparin with other injections or infusions.

 Lab Test Interferences Transaminase determinations: Drug causes asymptomatic elevations in AST and ALT.

 Adverse Reactions

DERM: Local erythema. HEMA: Hemorrhage; thrombocytopenia; anemia. OTHER: Local irritation and pain; hematoma; nausea; confusion; fever; edema; peripheral edema.

 Precautions

Pregnancy: Category B. Lactation: Undetermined. Children: Safety and efficacy not established. Elderly and debilitated patients: Delayed elimination of drug possible. Use with caution. Special-risk patients: Use drug with caution in patients with bleeding diathesis, uncontrolled arterial hypotension, or history of recent GI ulceration and hemorrhage. Hemorrhage: Use drug with extreme caution in patients with conditions associated with increased risk of hemorrhage. Interchangeability with heparin: Cannot be used interchangeably (unit for unit) with heparin. Renal impairment: Delayed elimination of drug may occur. Use with caution. Spinal/epidural anesthesia: Rare cases of neuraxial hemotoma have occurred with concurrent use of enoxaparin and spinal/epidural anesthesia, resulting in long-term or permanent paralysis. Thrombocytopenia: Use with extreme caution in patients who have a history of heparin-induced thrombocytopenia. Closely monitor any degree of thrombocytopenia.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Administer only by deep SC injection; enoxaparin cannot be administered via IM or IV injection.
  • With patient lying down, administer drug by SC injection. Alternate administration between left and right anterolateral and posterolateral abdominal wall. Introduce whole length of needle into skinfold held between thumb and forefinger; hold skinfold throughout injection.
  • Do not aspirate into syringe; do not rub site after injection. These activities may cause tissue damage and SC bleeding.
  • Store at room temperature. Do not freeze.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Review patient’s health history for any condition that could contraindicate enoxaparin (eg, active major bleeding, thrombocytopenia, hypersensitivity to enoxaparin, heparin, or pork products).
  • Review patient’s medication record for use of drugs that present special risks when used with enoxaparin (eg, anticoagulants, platelet inhibitors).
  • Obtain bleeding disorder laboratory tests before administering enoxaparin to assess for bleeding disorder.
  • Monitor patient for signs of bleeding throughout therapy.
  • Perform periodic CBCs (including platelet count) and stool occult blood tests during course of treatment.
  • If bleeding develops (eg, epistaxis, hematuria, hematemesis, bloody or black, tarry stools), notify physician immediately.
  • If laboratory studies for coagulation and bleeding are abnormal, notify physician.
OVERDOSAGE: SIGNS & SYMPTOMS
  Hemorrhage

 Patient/Family Education

  • Teach patient and family the name, action, administration, and side effects of enoxaparin.
  • Instruct patient to report any signs of bleeding immediately.
  • Explain to patient the rationale for follow-up examinations and laboratory studies to ensure effectiveness of medication and to monitor for side effects.
  • If patient has home therapy, teach patient or family proper SC injection technique.
  • Caution patient to take safety precautions to prevent cuts and bruising (eg, use electric razor, soft toothbrush, handrails).

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