En Ox A Par In

enoxaparin (en ocks' a par in) Lovenox Pregnancy Category B Drug classes

Low-molecular-weight heparin Antithrombotic Therapeutic actions

Low-molecular-weight heparin that inhibits thrombus and clot formation by blocking factor Xa, factor IIa, preventing the formation of clots. Indications

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Prevention of DVT, which may lead to pulmonary embolism following hip replacement, knee replacement surgery, abdominal surgery Prevention of ischemic complications of unstable angina and non–Q-wave MI Treatment of DVT, pulmonary embolus with warfarin Prevention of DVT in medical patients who are at risk for thromboembolic complications due to severely restricted mobility during acute illnesses

Contraindications and cautions

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Contraindicated with hypersensitivity to enoxaparin, heparin, pork products; severe thrombocytopenia; uncontrolled bleeding. Use cautiously with pregnancy or lactation, history of GI bleed.

Available forms

Injection—30 mg/0.3 mL; 40 mg/0.4 mL; 60 mg/0.6 mL; 80 mg/0.8 mL; 100 mg/1 mL; 90 mg/0.6 mL; 120 mg/0.8 mL; 150 mg/mL Dosages ADULTS

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DVT prophylaxis: 30 mg SC bid initial dose soon as possible after surgery, not more than 24 hr. Continue throughout the postoperative period for 7–10 days; then 40 mg daily SC for up to 3 wk may be used. Patients undergoing abdominal surgery: 40 mg/day SC begun within 2 hr preoperatively and continued for 7–10 days. Outpatient DVT treatment: 1 mg/kg SC q 12 hr. Unstable angina and non–Q-wave MI: 1 mg/kg SC q 12 hr for 2–8 days. Prevention of DVT in high-risk medical patients: 40 mg/day SC for 6–11 days, has been used up to 14 days.

PEDIATRIC PATIENTS

Safety and efficacy not established. Pharmacokinetics

Route SC

Onset 20–60 min

Peak 3–5 hr

Duration 12 hr

Metabolism: T1/2: 4.5 hr Distribution: May cross placenta; may enter breast milk Excretion: Urine Adverse effects

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Hematologic: Hemorrhage; bruising; thrombocytopenia; elevated AST, ALT levels; hyperkalemia Hypersensitivity: Chills, fever, urticaria, asthma Other: Fever; pain; local irritation, hematoma, erythema at site of injection

Interactions

Drug-drug • Increased bleeding tendencies with oral anticoagulants, salicylates, NSAIDs, penicillins, cephalosporins • Risk of severe bleeding if combined with heparin Drug-lab test • Increased AST, ALT levels Drug-alternative therapy • Increased risk of bleeding if combined with chamomile, garlic, ginger, ginkgo, and ginseng therapy Nursing considerations Assessment

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History: Recent surgery or injury; sensitivity to heparin, pork products, enoxaparin; lactation; history of GI bleed; pregnancy Physical: Peripheral perfusion, R, stool guaiac test, PTT or other tests of blood coagulation, platelet count, kidney function tests

Interventions

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Give drug as soon as possible after hip surgery, within 12 hr of knee surgery, and within 2 hr preoperatively for abdominal surgery. Give deep SC injections; do not give enoxaparin by IM injection. Administer by deep SC injection; patient should be lying down. Alternate between the left and right anterolateral and posterolateral abdominal wall. Introduce the whole length of the needle into a skin fold held between the thumb and forefinger; hold the skin fold throughout the injection. Apply pressure to all injection sites after needle is withdrawn; inspect injection sites for signs of hematoma; do not massage injection sites. Do not mix with other injections or infusions. Store at room temperature; fluid should be clear, colorless to pale yellow. Provide for safety measures (electric razor, soft toothbrush) to prevent injury to patient who is at risk for bleeding.

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Check patient for signs of bleeding; monitor blood tests. Alert all health care providers that patient is on enoxaparin. Discontinue and initiate appropriate therapy if thromboembolic episode occurs despite enoxaparin therapy. Have protamine sulfate (enoxaparin antidote) readily available in case of overdose. Treat overdose as follows: Protamine sulfate (1% solution). Each mg of protamine neutralizes 1 mg enoxaparin. Give very slowly IV over 10 min.

Teaching points

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Have periodic blood tests to monitor your response to this drug. You and a significant other may need to learn to give the drug by subcutaneous injection and how to properly dispose of needles and syringes. Avoid injury while you are on this drug: Use an electric razor; avoid activities that might lead to injury. Report nose bleed, bleeding of the gums, unusual bruising, black or tarry stools, cloudy or dark urine, abdominal or lower back pain, severe headache.

Adverse effects in Italic are most common; those in Bold are life-threatening.