Generic Drug Name:
enoxaparin
Brand/Trade Names:
(List 1-2 most common)
Drug Classification:
-anticoagulants
Location of metabolism/excretion:
Half/Life:
-Primarily renally eliminated
Nursing Implications/Assessment:
-Assess for signs of bleeding and hemorrhage (bleeding
gums; nosebleed; unusual bruising; black, tarry stools;
hematuria; fall in hematocrit or blood pressure; guaiacpositive stools); bleeding from surgical site.
-Assess patient for evidence of additional or increased
thrombosis.
-Monitor patient for hypersensitivity reactions (chills,
fever, urticaria).
-Monitor patients with epidural catheters frequently for
signs and symptoms of neurologic impairment
-3–6 hr
Lovenox
SC -Observe injection sites for hematomas, ecchymosis,
or inflammation
Indications for use:
-Prevention of deep vein
thrombosis (DVT) and
pulmonary embolism
(PE) in surgical and
medical patients
-Treatment of deep vein
thrombosis (with
warfarin)
-Prevention of ischemic
complications (with
aspirin) from
-unstable angina
-non–Q-wave MI
Contraindications:
-Hypersensitivity
-Hypersensitivity to benzyl
alcohol (multidose vial)
-Positive in vitro test for
antiplatelet antibody in the
presence of enoxaparin
-Active, major bleeding
Onset/Peak/Duration for Insulin:
ROUTE ONSET
Subcut
PEAK
DURATION
unknown unknown 12 hr
Key Patient Teaching Points:
-Advise patient to report any symptoms of unusual
bleeding or bruising, dizziness, itching, rash, fever,
swelling, or difficulty breathing to health care
professional immediately
-Instruct patient not to take aspirin, naproxen, or
ibuprofen without consulting health care professional
while on enoxaparin therapy
Action:
-Potentiates the
inhibitory effect of
antithrombin on factor
Xa and thrombin
Adverse Reactions/Side
Effects:
Routes and Dosage range
for each route:
dizziness, headache,
insomnia,bleeding, anemia,
thrombocytopenia.
Therapeutic Effects:
(expected outcome)
Interactions:
-Risk of bleeding may be ↑ by
concurrent use of drugs that
affect platelet function and
coagulation , including
warfarin, aspirin, thrombolytic
agents, NSAIDs, dipyridamole,
some penicillins, clopidogrel,
abciximab, eptifibatide,
tirofiban, ticlopidine, and
dextran
DVT Prophylaxis
• SC (Adults):
Knee replacement surgery —30 mg q 12 hr
starting 12–24 hr after surgery;
Hip replacement—40 mg 12 hr before
surgery then once daily; may be continued
for up to 3 wk after hospital discharge;
Abdominal surgery—40 mg 2 hr prior to
surgery, then every 24 hr postop for 7–12
days or until ambulatory (up to 14 days);
Medical patients with acute illness—40 mg
once daily.
Treatment of DVT/PE
• SC (Adults):
Outpatient —1 mg/kg every 12 hr;
Inpatient —1 mg/kg every 12 hr or 1.5
mg/kg every 24 hr. Warfarin should be
started within 72 hr; enoxaparin may be
continued for 5–17 days or until therapeutic
anticoagulation with warfarin is achieved
(INR >2 for two consecutive days).
Angina/Non–Q-wave MI
• SC (Adults): 1 mg/kg q 12 hr for 2–8 days
(up to 12.5 days).
Renal Impairment
• SC (Adults CCr < 30 ml/min):
DVT prophylaxis for abdominal, knee or hip
surgery —30 mg once daily;
Angina/Non–Q-wave MI, treatment of
DVT—1 mg/kg once daily;
-Prevention of thrombus
formation
Evaluation criteria:
-Monitor CBC, platelet count, and stools for occult blood
periodically during therapy. If thrombocytopenia occurs,
monitor closely. If hematocrit decreases unexpectedly,
assess patient for potential bleeding sites
-Special monitoring of clotting times (aPTT) is not
necessary in most patients. Monitoring of the aPTT may
be considered in certain patient populations (such as
obese patients or patients with renal insufficiency)
-May cause ↑ in AST and ALT levels
-May cause hyperkalemia
Labs to monitor (if applicable):
-Prevention of deep vein thrombosis and pulmonary
embolism
-Resolution of acute deep vein thrombosis
-Prevention of ischemic complications (with aspirin) in
patients with unstable angina or non-Q-wave MI