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Epidural or spinal hematomas may occur in patients who are anticoagulated with low molecular weight heparins (LMWH) or heparinoids and are receiving neuraxial anesthesia or undergoing spinal puncture. These hematomas may result in long-term or permanent paralysis. Consider these risks when scheduling patients for spinal procedures. Factors that can increase the risk of developing epidural or spinal hematomas in these patients include:
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Use of indwelling epidural catheters
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Concomitant use of other drugs that affect hemostasis, such as non-steroidal anti-inflammatory drugs (NSAIDs), platelet inhibitors, other anticoagulants.
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A history of traumatic or repeated epidural or spinal punctures
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A history of spinal deformity or spinal surgery
Monitor patients frequently for signs and symptoms of neurological impairment. If neurological compromise is noted, urgent treatment is necessary.
Consider the benefits and risks before neuraxial intervention in patients anticoagulated or to be anticoagulated for thromboprophylaxis [see
Warnings and Precautions
and
Drug Interactions (7)
].
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LOVENOX SUMMARY
Lovenox is a sterile aqueous solution containing enoxaparin sodium, a low molecular weight heparin.
Prophylaxis of Deep Vein Thrombosis
Lovenox® is indicated for the prophylaxis of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE):
- in patients undergoing abdominal surgery who are at risk for thromboembolic complications [see
Clinical Studies
].
- in patients undergoing hip replacement surgery, during and following hospitalization.
- in patients undergoing knee replacement surgery.
- in medical patients who are at risk for thromboembolic complications due to severely restricted mobility during acute illness.
Treatment of Acute Deep Vein Thrombosis
Lovenox is indicated for:
- the inpatient treatment of acute deep vein thrombosis with or without pulmonary embolism, when administered in conjunction with warfarin sodium.
- the outpatient treatment of acute deep vein thrombosis without pulmonary embolism when administered in conjunction with warfarin sodium.
Prophylaxis of Ischemic Complications of Unstable Angina and Non-Q-Wave Myocardial Infarction
Lovenox is indicated for the prophylaxis of ischemic complications of unstable angina and non-Q-wave myocardial infarction, when concurrently administered with aspirin.
Treatment of Acute ST-Segment Elevation Myocardial Infarction
Lovenox, when administered concurrently with aspirin, has been shown to reduce the rate of the combined endpoint of recurrent myocardial infarction or death in patients with acute ST-segment elevation myocardial infarction (STEMI) receiving thrombolysis and being managed medically or with percutaneous coronary intervention (PCI).
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NEWS HIGHLIGHTSMedia Articles Related to Lovenox (Enoxaparin)
DVT (Deep Vein Thrombosis) and Pulmonary Embolism (PE) Quiz
Source: MedicineNet Deep Vein Thrombosis Specialty [2017.09.20]
Title: DVT (Deep Vein Thrombosis) and Pulmonary Embolism (PE) Quiz
Category: MedicineNet Quiz
Created: 7/31/2014 12:00:00 AM
Last Editorial Review: 9/20/2017 1:12:43 PM
Deep Vein Thrombosis (DVT, Blood Clot in the Legs)
Source: MedicineNet Antiphospholipid Syndrome Specialty [2017.07.03]
Title: Deep Vein Thrombosis (DVT, Blood Clot in the Legs)
Category: Diseases and Conditions
Created: 2/15/2000 12:00:00 AM
Last Editorial Review: 7/3/2017 12:00:00 AM
Deep Vein Thrombosis (DVT)
Source: MedicineNet Deep Vein Thrombosis Specialty [2017.05.22]
Title: Deep Vein Thrombosis (DVT)
Category: Symptoms and Signs
Created: 2/26/2015 12:00:00 AM
Last Editorial Review: 5/22/2017 12:00:00 AM
Published Studies Related to Lovenox (Enoxaparin)
Darexaban (YM150) versus enoxaparin for the prevention of venous thromboembolism
after total hip arthroplasty: a randomised phase IIb dose confirmation study
(ONYX-3). [2014]
This double-blind, double-dummy, randomised, phase IIb study (NCT00902928)
evaluated different dosing regimens of darexaban compared with enoxaparin
(randomised 1:1:1:1:1 to 15 mg twice daily [bid], 30 mg once daily [qd], 30 mg
bid or 60 mg qd or enoxaparin 40 mg qd) in patients undergoing elective total hip
arthroplasty.
Safety and efficacy of edoxaban, an oral factor Xa inhibitor, versus enoxaparin
for thromboprophylaxis after total knee arthroplasty: the STARS E-3 trial. [2014]
Taiwan... CONCLUSIONS: Edoxaban 30 mg once daily was more effective for thromboprophylaxis
Impact of stage 3B chronic kidney disease on thrombosis and bleeding outcomes
after orthopedic surgery in patients treated with desirudin or enoxaparin:
insights from a randomized trial. [2012]
enoxaparin after elective THR... CONCLUSIONS: CKD has been reported previously to increase the risk of bleeding
Apixaban versus enoxaparin for thromboprophylaxis after hip or knee replacement:
pooled analysis of major venous thromboembolism and bleeding in 8464 patients
from the ADVANCE-2 and ADVANCE-3 trials. [2012]
In order to compare the effect of oral apixaban (a factor Xa inhibitor) with
subcutaneous enoxaparin on major venous thromboembolism and major and non-major
clinically relevant bleeding after total knee and hip replacement, we conducted a
pooled analysis of two previously reported double-blind randomised studies
involving 8464 patients...
Comparison of enoxaparin and unfractionated heparin in endovascular interventions for the treatment of peripheral arterial occlusive disease: a randomized controlled trial. [2011.11]
BACKGROUND: Although unfractionated heparin (UFH) is an effective antithrombotic agent in endovascular interventions for the treatment of peripheral occlusive arterial disease (PAOD), it produces a highly variable anticoagulant response. Intravenous (i.v.) enoxaparin might be an effective and safe alternative... CONCLUSION: Enoxaparin has a better performance than UFH in endovascular interventions for the treatment of PAOD. In patients with concomitant use of ASA, the risk of complications with UFH increases significantly compared with enoxaparin. (c) 2011 International Society on Thrombosis and Haemostasis.
Clinical Trials Related to Lovenox (Enoxaparin)
Bioavailability Study of Enoxaparin Sodium Chemi and Clexane s.c. [Completed]
This will be an open-label, randomised, single-dose, 2-way crossover study to determine the
comparative bioavailability of enoxaparin sodium from the Chemi Enoxaparin s. c. (80
mg/0. 8mL) with that from the reference IMP, Clexane® s. c. (80 mg/0. 8mL), following single
dose administration in healthy male and female subjects.
Comparison of Anti-Xa Activity of ENOXA � Versus LOVENOX � in Acute Coronary Syndrome [Completed]
This study is a clinical trial monocentric, open, randomized ENOXA ® versus LOVENOX ®,
conducted on two parallel groups of patients admitted in emergency for acute coronary
syndrome.
Enoxamed Study in the Treatment of Acute Coronary Syndromes [Completed]
Because of their anti-Xa and ease of administration activity, the Low molecular weight
heparin represent an attractive alternative to the unfractionated heparin. Several clinical
trials have demonstrated that Low molecular weight heparin was more effective than
Unfractionated heparin without increasing bleeding complications. Enoxaparin has been the
most studied. Its use is recommended.
Demonstrate that Enoxamed® is comparable to that of Lovenox® in the anti-Xa activity action.
A Randomized Study to Evaluate the Effect of Two Different Doses of Enoxaparin Sodium in Combination With Standard Chemotherapy in Patients With Stage Small Cell Lung Cancer (SCLC) [Withdrawn]
The purpose of this research study is to see if adding enoxaparin sodium to standard
treatment with the chemotherapy drugs cisplatin and etoposide will help treat extensive
stage SCLC. Two different doses of enoxaparin sodium will be studied in order to determine
if one dose is more effective than the other. Enoxaparin sodium (Lovenox) is a drug that is
approved by the FDA to help treat or prevent blood clots. Results from previous research
studies suggest that adding enoxaparin sodium to standard treatment improved the response to
treatment for some study participants with various types of cancer.
A Single-Dose Study to Examine the Within Subject Variability of Clexane® in Healthy Adult Subjects Under Fasting Conditions [Completed]
This is a pilot, open-label study aimed at a preliminary evaluation of enoxaparin
bioavailability following two administrations of Clexane s. c. at a dose of 80mg, in two
different periods.
Reports of Suspected Lovenox (Enoxaparin) Side Effects
Dyspnoea (42),
Thrombocytopenia (39),
Anaemia (39),
Haematoma (38),
Hypotension (37),
Oedema Peripheral (33),
Pulmonary Embolism (29),
Cytolytic Hepatitis (28),
Deep Vein Thrombosis (26),
Thrombosis (25), more >>
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PATIENT REVIEWS / RATINGS / COMMENTSBased on a total of 2 ratings/reviews, Lovenox has an overall score of 7.50. The effectiveness score is 10 and the side effect score is 9. The scores are on ten point scale: 10 - best, 1 - worst.
| | Lovenox review by 30 year old female patient | | | Rating |
| Overall rating: | |  |
| Effectiveness: | | Highly Effective |
| Side effects: | | Mild Side Effects | | |
Treatment Info |
| Condition / reason: | | Blood thinning/ circulation during pregnancy |
| Dosage & duration: | | 30 mg/ml taken twice a day for the period of 9 months |
| Other conditions: | | None |
| Other drugs taken: | | Low dose aspirin | | |
Reported Results |
| Benefits: | | Lovenox is given in subsequent pregnancies to women with recurrent miscarriage due to autoimmune issues. Prior to taking Lovenox, I had two second trimester losses and thanks to Lovenox I was able to carry my two daughters to term. It allowed my placenta to last the pregnancy without clotting and I was able to successfully have two children. |
| Side effects: | | There are no major side effects. There is an increased risk of bleeding but I did not experience this. The only mild side effects was burning at the site of the injection when the medicine was going in, and some bruising at the site of the injection. Other than this I did not experience any sorts of side effects what so ever. |
| Comments: | | I had to self administer the shots twice a day. Lovenox shots are primarily given on the belly. However, the area usually remains sensitive and for anyone taking the drug for a prolonged period of time like I was, eventually you will run out of spots in your abdominal area and have to move to the thigh (I had to move to the thigh area during my last month of pregnancy). Other than slight burning and bruising, there was no other issues. Initially I had a hard time giving myself the shot, and my husband had to do it, but once you get used to it, it's not really that bad and I was able to do it easily later on. I was supposed to start the shots prior to conception and continue them six weeks postpartum. My overall experience with Lovenox is very good and I am very happy that this drug was around to help me. |
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| | Lovenox review by 38 year old female patient | | | Rating |
| Overall rating: | |  |
| Effectiveness: | | Highly Effective |
| Side effects: | | No Side Effects | | |
Treatment Info |
| Condition / reason: | | Blood clot as a cause of early stage misscarriage |
| Dosage & duration: | | 40mg/0.4ml taken subcutaneous injection/on my own for the period of 60 days |
| Other conditions: | | none |
| Other drugs taken: | | baby asperin | | |
Reported Results |
| Benefits: | | I had two early stage miscarriages, so I was tested by a reproductive specialist. She diagnosed that I have high blood clot factor. As soon as the third pregnancy was confirmed (5th week), I stated to take Lovenox once a day. After reaching 13th week and ultrasound confirmed the baby is growing well, I was allow to be off Lovenox. I am now in third trimester and my pregnancy went well. |
| Side effects: | | There was no side effect, however I really hated giving injection to myself. I was so painfull. The injection spot became bruised, even though I iced it right away after injection. And the bruises did not heal for a week to two weeks. I picked different injection spot every day to avoid the bruised area, so my abdomen was purple for the 9 weeks. |
| Comments: | | As memtioned above in treatment benefits, this drug was used to avoid recurrance of early stage miscarriage. The high blood clot factor originates from two reasons: for one my husband and I share two HLA, and two I have condition so called antiphospholipid syndrome. To reduce the factor I was directed to take baby asperin and Lovenox. Once I reached 13th week when the plecenta is well establised and growth of baby was well, my doctor decided Lovenox is no longer needed and baby asperin alone be fine onward. |
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Page last updated: 2017-09-20
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