Enoxaparin (Lovenox)
Anticoagulant | Blood Modifier Agent
Lovenox, generically known as enoxaparin, is a low molecular weight heparin used primarily for the prevention and treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE).
- Dosing Variability: Dosing of enoxaparin must be individualized based on the patient's kidney function, body weight, and reason for use. Always check renal function before initiating therapy, as dosage adjustments may be needed in patients with renal impairment to prevent accumulation and increased bleeding risk.
- Subcutaneous Administration: Enoxaparin should be administered via subcutaneous injection. Proper technique is essential including injecting into the fatty layer of the abdomen, at least 2 inches away from the belly button, and alternating sites. Do not expel the air bubble in the syringe prior to injection, as it is meant to ensure the entire dose is administered.
- Monitoring Parameters: Routine monitoring of anti-factor Xa levels is generally not required but can be helpful in certain populations such as those with significant renal impairment, obesity, or pregnant patients to ensure therapeutic levels.
- Bleeding Risks: Be vigilant for signs of bleeding in patients on enoxaparin. This includes hidden bleeding such as gastrointestinal bleeds. Inform patients about potential bleeding symptoms and when to seek immediate medical attention.
- Drug Interactions: Caution should be exercised when using enoxaparin with other medications that affect hemostasis such as NSAIDs, other anticoagulants, and certain antidepressants (e.g., SSRIs, SNRIs) as these can increase the risk of bleeding.
- Bridging Therapy: Enoxaparin is often used for bridging therapy when warfarin is being initiated until therapeutic INR levels are achieved. The two drugs have overlapping anticoagulant effects necessary when transitioning therapies.
- Transition to Oral Anticoagulants: Ensure proper overlap (usually at least 5 days and until INR is therapeutic for at least 24 hours) when transitioning from enoxaparin to warfarin.
- Management of Overdose: There is no specific antidote for enoxaparin overdose. In cases where anticoagulation needs to be reversed, protamine sulfate may be used, though it only partially reverses the effects of enoxaparin.
- Use in Special Populations: Special care is needed in the elderly who are more prone to renal impairment, and in pregnant women, where enoxaparin is preferred over other anticoagulants because it does not cross the placenta.
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