Enoxaparin (Lovenox®) Considerations for Use*
Non-FDA Approved Indication: Alternative to Oral Anticoagulation for Stroke Prevention in Atrial Fibrillation
|Black Box Warning*||Epidural and spinal hematomas may occur in patients who are anticoagulated and are receiving neuraxial anesthesia or undergoing spinal punctures.|
Mechanism of Action
A low molecular weight heparin with antithrombotic properties
Adult: 1 mg/kg twice daily2
Elderly: No specific dosage adjustment
Hepatic Impairment: No specific dosage adjustment
Active pathological bleeding , thrombocytopenia, history of heparin - induced thrombocytopenia, pork allergy
|Major Side Effects||
Hemorrhagic event, heparin-induced thrombocytopenia
|Dosage forms and Strengths||
SQ: solution for injection
Discontinue enoxaparin. Anticoagulation effects should be minimized within 12 hours.
Protamine, given as a slow IV infusion (1 % solution), may largely neutralize enoxaparin.
|Conversion to/from other drugs||
From enoxaparin to warfarin :
Monitor for signs and symptoms of bleeding.
Monitor hemoglobin, hematocrit, platelets, stool for occult blood.
Consider monitoring anti-Xa activity (goal 0.3 to 0.7 IU/mL antifactor Xa activity) with severe renal dysfunction, weight < 45 kg, or obese patients.
Discontinue all heparin products when heparin induced thrombocytopenia is suspected or diagnosed.
Not adequately studied in patients with mechanical heart valves.
Report signs and symptoms of bleeding (e.g., unexpected bleeding or bleeding that lasts a long time; red or black, tarry stool; pink or brown urine; unusual bruising; coughing up blood; vomiting blood or vomit that looks like coffee grounds; unexplained pain, swelling, or joint pain; unusual headaches, dizziness, or weakness; recurring nose bleeds)
*Refer to prescribing information for more complete information.
†Dosages given in the table may differ from those recommended by the manufacturers.
- American College of Cardiology (ACC), American Heart Association (AHA), and Heart Rhythm Society (HRS). 2011 ACCF/AHA/HRS Focused Update on the Management of Patients With Atrial Fibrillation (Update on Dabigatran). Washington, DC: American College of Cardiology Foundation. 2011.
- Chest Supplement, Antithrombotic Therapy and Prevention of Thrombosis, 9th edition, American College of Chest Physicians.
- Lovenox® prescribing information, 5/16/07.