Indications for: LOVENOX
Prevention of DVT in hip or knee replacement surgery, or in abdominal surgery or acutely ill patients with severely restricted mobility at risk for thromboembolism. With warfarin: for inpatient treatment of acute DVT with or without pulmonary embolism (PE), or outpatient treatment of acute DVT without PE. With aspirin: to prevent ischemic complications of unstable angina and non-Q-wave MI. Treatment of acute ST-segment elevation MI (STEMI) managed medically or with subsequent percutaneous coronary intervention (PCI).
For post-op dosing, assure hemostasis before starting. Knee: 30mg SC every 12hrs for 7–10 days; max 14 days (1st dose 12–24hrs post-op). Hip: 30mg SC every 12hrs (1st dose 12–24hrs post-op), or 40mg SC once daily (1st dose 9–15hrs pre-op), for 7–10 days, then 40mg SC once daily for 3 weeks. Abdominal: 40mg SC once daily (1st dose 2hrs pre-op) for 7–10 days; max 12 days. Severely restricted mobility due to acute illness: 40mg SC once daily for 6–11 days, max 14 days. DVT (without PE) outpatient: 1mg/kg every 12hrs SC; inpatient (with or without PE): 1mg/kg every 12hrs SC or 1.5mg/kg once daily SC; for both, start warfarin usually within 72hrs, continue enoxaparin at least 5 days and until INR is between 2–3 (usually 7 days; usual max 17 days). Unstable angina and non-Q-wave MI: 1mg/kg SC every 12hrs for at least 2 days, with aspirin 100–325mg once daily, until stable (usually 2–8 days; usual max 12.5 days). STEMI: 30mg IV bolus plus 1mg/kg SC dose, then 1mg/kg SC every 12hrs (max 100mg for 1st 2 doses only, then 1mg/kg dosing for remaining doses), with aspirin 75–325mg once daily; usually for 8 days or until hospital discharge. Concomitant thrombolytics: give between 15mins before or 30mins after start of fibrinolytic therapy. PCI: if last enoxaparin dose given <8hrs before balloon inflation, no additional dose needed; >8hrs before balloon inflation, give 0.3mg/kg IV bolus. Elderly with STEMI: ≥75yrs: Do not give IV bolus; initially 0.75mg/kg SC every 12hrs (max 75mg for 1st 2 doses only, then 0.75mg/kg dose for remaining doses). Severe renal impairment (CrCl<30mL/min) or low body weight: adjust dose (see full labeling).
Active major bleeding. History of immune-mediated heparin-induced thrombocytopenia (HIT) within the past 100 days or in the presence of circulating antibodies. Hypersensitivity to heparin, pork products, or benzyl alcohol (in multidose vials).
Prosthetic heart valves: not recommended (esp. if pregnant). Neuraxial anesthesia and post-op indwelling epidural catheter or spinal puncture (risk of epidural or spinal hematoma: see full labeling). History of spinal surgery or deformity. Monitor for signs/symptoms of neurological impairment. Bacterial endocarditis. Congenital or acquired bleeding disorders. Active ulceration and angiodysplastic GI disease. Hemorrhagic stroke. Recent brain, spinal or eye surgery. Bleeding diathesis. Uncontrolled hypertension. Recent history of GI ulcer. Diabetic retinopathy. Renal or hepatic impairment. Low body weight (monitor bleeding). Obese (monitor for thromboembolism). PCI: obtain hemostasis before sheath removal; monitor site for bleeding or hematoma (see full labeling). History of HIT: do benefit/risk assessment and consider non-heparin alternative treatments prior to use. Monitor for thrombocytopenia; discontinue if platelets fall <100000/mm3. Monitor CBCs, platelets, and for occult blood in stool. Not interchangeable (unit-for-unit) with heparin or other low molecular weight heparins. Elderly. Pregnancy: monitor carefully (bleeding or excessive anticoagulation); use preservative-free formulations (syringes). Nursing mothers.
Low molecular weight heparin.
Avoid concomitant drugs that affect hemostasis (eg, oral anticoagulants, platelet inhibitors including aspirin, NSAIDs, dipyridamole, sulfinpyrazone).
Bleeding (may be serious), anemia, thrombocytopenia, elevated serum transaminases, diarrhea, nausea, inj site reactions, ecchymosis, fever, edema; angina/MI patients: also atrial fibrillation, heart failure, lung edema, pneumonia; spinal/epidural hematoma.
Prefilled syringes 100mg/mL (30mg, 40mg)—10; Graduated prefilled syringes 100mg/mL (60mg, 80mg, 100mg)—10; Graduated prefilled syringes 150mg/mL (120mg, 150mg)—10; Multidose vial (300mg/3mL)—1