ENOXAPARIN
(e-nox'a-pa-rin)
Lovenox
Classifications: blood formers, coagulators, and anticoagulants; low molecular weight heparin
Pregnancy Category: B

Availability

30 mg/0.3 mL, 40 mg/0.4 mL, 60 mg/0.6 mL, 80 mg/0.8 mL, 100 mg/1 mL injection

Actions

Low molecular weight heparin with antithrombotic properties. Does not affect PT. Does affect thrombin time (TT) and activated thromboplastin time (aPTT) up to 1.8 times the control value.

Therapeutic Effects

Antithrombotic properties are due to its antifactor Xa and antithrombin (antifactor IIa) in the coagulation activities. An effective anticoagulation agent; used for prophylactic treatment as an antithrombotic agent following certain types of surgery.

Uses

Prevention of deep vein thrombosis (DVT) after hip, knee, or abdominal surgery, treatment of DVT and pulmonary embolism, management of acute coronary syndrome.

Contraindications

Patients with active major bleeding, GI bleeding, hemophilia, heparin hypersensitivity, heparin-induced thrombocytopenia (HIT), thrombocytopenia associated with an antiplatelet antibody in the presence of enoxaparin, bleeding disorders, idiopathic thrombocytopenia purpura (ITP), hypersensitivity to enoxaparin; porcine protein hypersensitivity, neonates.

Cautious Use

Uncontrolled arterial hypertension, recent history of GI disease, benzyl alcohol hypersensitivity, conditions or surgery with increased risk of bleeding, hepatic disease, hypertension, coagulopathy, thrombolytic therapy, thrombocytopenia, dental disease, dental work, diabetic retinopathy, dialysis, diverticulitis, inflammatory bowel disease, intramuscular injections, lumbar puncture, menstruation, obesity, peptic ulcer disease, older adults, endocarditis, renal disease, renal impairment, spinal anesthesia, stroke, surgery, pregnancy (category B), lactation. Safety and effectiveness in children are not established.

Route & Dosage

Prevention of DVT after Hip or Knee Surgery
Adult: SC 30 mg b.i.d. for 10–14 d starting 12–24 h post-surgery

Prevention of DVT after Abdominal Surgery
Adult: SC 40 mg q.d. starting 2 h before surgery and continuing for 7–10 d (max: 12 d)

Treatment of DVT and Pulmonary Embolus
Adult: SC 1 mg/kg q12h or 1.5 mg/kg/d; monitor anti-Xa activity to determine appropriate dose

Acute Coronary Syndrome
Adult: SC 1 mg/kg q12h for 2–8 d, give concurrently with aspirin 100–325 mg/d

Adjustment for Renal Impairment
Clcr <30 mL/min: 30 mg or 1 mg/kg q24h

Administration

Subcutaneous

Adverse Effects (1%)

Body as a Whole: Allergic reactions (rash, urticaria), fever, angioedema arthralgia, pain and inflammation at injection site, peripheral edema, arthralgia, fever. Digestive: Abnormal liver function tests. Hematologic: Hemorrhage , thrombocytopenia, ecchymoses, anemia. Respiratory: Dyspnea. Skin: Rash, pruritus.

Interactions

Drug: Aspirin, nsaids, warfarin can increase risk of hemorrhage. Herbal: Garlic, ginger, ginkgo, feverfew, horse chestnut may increase risk of bleeding.

Pharmacokinetics

Absorption: 91% absorbed from SC injection site. Peak: 3 h. Duration: 4.6 h. Distribution: Appears to accumulate in liver, kidneys, and spleen. Does not cross placenta. Elimination: Primarily excreted in urine. Half-Life: 4.6 h.

Nursing Implications

Assessment & Drug Effects

Patient & Family Education


Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug