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enoxaparin (Lovenox)

Tradename: Lovenox. (see low molecular weight heparin) Dosage: 1) 1 mg/kg SC BID (full anticoagulation) -> QD-dosing if creatinine clearance < 30 mL/min [6,7] 2) DVT prophylaxis: a) 30 mg SC BID b) 40 mg SC QD c) 30 mg SC QD if creatinine clearance < 30 mL/min [6,7] 3) overlap with warfarin therapy, discontinue when INR is therapeutic for 2 consecutive days 4) discontinue for 12 hours prior to surgery 30 & 40 mL syringes Dosage adjustment in renal failure: - lower dose with eGFR < 30 mL/min [9] Pharmacokinetics: 1) bioavailability is 90% following SC administration 2) 1/2life is 4 hours 3) duration of action is 12 hours 4) elmination is prolonged with renal insufficiency Adverse effects: 1) bruising, bleeding -> minor bleeding more common than with heparin in patients with severe renal insufficiency [7] 2) see heparin, LMW heparin Overdose - treat with protamine sulfate [3] Mechanism of action: -> inhibits coagulation factor Xa

Interactions

drug adverse effects of LMW heparin

General

low molecular weight (LMW) heparin

Database Correlations

PUBCHEM cid=772

References

  1. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  2. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  3. Medical Knowledge Self Assessment Program (MKSAP) 11, 16. American College of Physicians, Philadelphia 1998, 2013
  4. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  5. Prescriber's Letter 7(12):72 2000
  6. Prescriber's Letter 11(2):9 2004 Detail-Document#: 200204 (subscription needed) http://www.prescribersletter.com
  7. Journal Watch 24(10):78, 2004 Thorevska N, Amoateng-Adjepong Y, Sabahi R, Schiopescu I, Salloum A, Muralidharan V, Manthous CA. Anticoagulation in hospitalized patients with renal insufficiency: a comparison of bleeding rates with unfractionated heparin vs enoxaparin. Chest. 2004 Mar;125(3):856-63. PMID: 15006942
  8. Samama MM, Cohen AT, Darmon JY et al A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. Prophylaxis in Medical Patients with Enoxaparin Study Group. N Engl J Med. 1999 Sep 9;341(11):793-800. PMID: 10477777 Free Article
  9. A Pocket Guide to the 2019 Beer's Criteria. American Geriatrics Society.