ENOXAPARIN

ENOXAPARIN (e-nox'a-pa-rin) Lovenox Classifications: anticoagulant; low molecular weight heparin; Therapeutic:antithrombotic; 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

Action

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. Antithrombotic properties are due to its antifactor Xa and antithrombin (antifactor IIa) in the coagulation activities.

Therapeutic Effect

An effective anticoagulation agent, it is 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 ST elevation myocardial infarction (STEMI), non-Q wave MI.

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, infants and children.

Cautious Use

Uncontrolled arterial hypertension, recent history of GI disease, conditions or surgery with increased risk of bleeding, hepatic disease, hypertension, coagulopathy, thrombocytopenia, dental disease, diabetic retinopathy, dialysis, diverticulitis, inflammatory bowel disease, peptic ulcer disease, older adults, endocarditis, renal disease, renal impairment, stroke, surgery, pregnancy (category B), lactation.

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 Non-Q Wave MI Adult: SC 1 mg/kg q12h for 2–8 d, give concurrently with aspirin 100–325 mg/d Acute STEMI Adult: SC 30 mg bolus plus 1 mg/kg, then 1 mg/kg q12h Renal Impairment Clcr <30 mL/min: 30 mg or 1 mg/kg q24h

Administration

Subcutaneous

• Use a TB syringe or prefilled syringe to ensure accurate dosage.
• Do not expel the air bubble from the 30 or 40 mg prefilled syringe before injection.
• Place patient in a supine position for injection of the drug.
• Alternate injections between left and right anterolateral and posterolateral abdominal wall.
• Hold the skin fold between the thumb and forefinger and insert the whole length of the needle into the skin fold. Hold skin fold throughout the injection. Do not rub site post injection.
• Store at 15°–30° C (59°–86° F).

Adverse Effects (≥1%)

Body as a Whole: Allergic reactions (rash, urticaria), fever, angioedema, arthralgia, pain and inflammation at injection site, peripheral edema, 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 in urine. Half-Life: 4.6 h.

Nursing Implications

Assessment & Drug Effects

• Lab tests: Baseline coagulation studies; periodic CBC, platelet count, urine and stool for occult blood.
• Monitor platelet count closely. Withhold drug and notify physician if platelet count less than 100,000/mm³.
• Monitor closely patients with renal insufficiency and older adults who are at higher risk for thrombocytopenia.
• Monitor for and report immediately any sign or symptom of unexplained bleeding.

Patient & Family Education

• Report to physician promptly signs of unexplained bleeding such as: pink, red, or dark brown urine; red or dark brown vomitus; bleeding gums or bloody sputum; dark, tarry stools.
• Do not take any OTC drugs without first consulting physician.

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