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Lovenox (Enoxaparin Sodium) - Summary

 
 



WARNING: SPINAL/EPIDURAL HEMATOMAS

When neuraxial anesthesia (epidural/spinal anesthesia) or spinal puncture is employed, patients anticoagulated or scheduled to be anticoagulated with low molecular weight heparins or heparinoids for prevention of thromboembolic complications are at risk of developing an epidural or spinal hematoma which can result in long-term or permanent paralysis.

The risk of these events is increased by the use of indwelling epidural catheters for administration of analgesia or by the concomitant use of drugs affecting hemostasis such as non steroidal anti-inflammatory drugs (NSAIDs), platelet inhibitors, or other anticoagulants. The risk also appears to be increased by traumatic or repeated epidural or spinal puncture.

Monitor patients for signs and symptoms of neurological impairment. If neurologic compromise is noted, urgent treatment is necessary.

Consider the potential benefit versus risk before neuraxial intervention in patients anticoagulated or to be anticoagulated for thromboprophylaxis [see Warnings and Precautions and Drug Interactions (7) ].

 

LOVENOX SUMMARY

Lovenox Injection is a sterile aqueous solution containing enoxaparin sodium, a low molecular weight heparin.

  • Lovenox Injection is indicated for the prophylaxis of deep vein thrombosis, which may lead to pulmonary embolism:
    • in patients undergoing abdominal surgery who are at risk for thromboembolic complications;
    • 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.
  • Lovenox Injection is indicated for the prophylaxis of ischemic complications of unstable angina and non-Q-wave myocardial infarction, when concurrently administered with aspirin.
  • Lovenox Injection 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.

See all Lovenox indications & dosage >>

NEWS HIGHLIGHTS

Media Articles Related to Lovenox (Enoxaparin)

Patients with high BMI benefit considerably from apixaban for deep vein thrombosis and pulmonary embolism
Source: Cardiovascular / Cardiology News From Medical News Today [2014.12.10]
In contrast, no added benefit proven in initial treatment of patients with BMI up to 28 kg/m2 and in long-term preventionApixaban (trade name Eliquis) has been approved since July 2014 for acute...

Deep Vein Thrombosis (DVT)
Source: MedicineNet Antiphospholipid Syndrome Specialty [2013.11.29]
Title: Deep Vein Thrombosis (DVT)
Category: Diseases and Conditions
Created: 2/15/2000 10:55:00 PM
Last Editorial Review: 11/29/2013 12:00:00 AM

'Increased risk of venous thromboembolism among NSAID users'
Source: Body Aches News From Medical News Today [2014.09.25]
Venous thromboembolism - the condition that includes both deep vein thrombosis and pulmonary embolism - has been linked to NSAID use in a new systematic review and meta-analysis.

more news >>

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.

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.

Intravenous enoxaparin or unfractionated heparin in primary percutaneous coronary intervention for ST-elevation myocardial infarction: the international randomised open-label ATOLL trial. [2011.08.20]
BACKGROUND: Primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction has traditionally been supported by unfractionated heparin, which has never been directly compared with a new anticoagulant using consistent anticoagulation and similar antiplatelet strategies in both groups. We compared traditional heparin treatment with intravenous enoxaparin in primary PCI... INTERPRETATION: Intravenous enoxaparin compared with unfractionated heparin significantly reduced clinical ischaemic outcomes without differences in bleeding and procedural success. Therefore, enoxaparin provided an improvement in net clinical benefit in patients undergoing primary PCI. FUNDING: Direction de la Recherche Clinique, Assistance Publique-Hopitaux de Paris; Sanofi-Aventis. Copyright (c) 2011 Elsevier Ltd. All rights reserved.

more studies >>

Clinical Trials Related to Lovenox (Enoxaparin)

Safety Evaluation of Use Sodic Enoxaparin [Completed]
The purpose of this study was to evaluate safety, not inferiority clinical and pharmacodynamic profile of the drug Enoxaparin Sodium produced by laboratory Blausiegel when compared with Clexane product, produced by Laboratory Sanofi-Aventis in 60 patients with Chronic Renal Desease.

Comparison of Anti-Xa Activity of ENOXA � Versus LOVENOX � in Acute Coronary Syndrome [Recruiting]
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.

Enoxaparin Thromboprophylaxis in Cancer Patients With Elevated Tissue Factor Bearing Microparticles [Recruiting]
Research studies have shown a strong association between cancer and blood clots in the veins (also known as deep vein thrombosis). These blood clots can flow to the lungs (pulmonary embolism) which in severe cases may be life threatening. The purpose of this research study is to see if enoxaparin is effective in preventing blood clots in the veins in participants who have cancer of the pancreas, colorectal, non-small cell lung, ovary, or gastric and also have high levels of tissue factor bearing microparticles in their blood (TFMP). TFMP are small particles that are generated from different types of blood cells in the body. In people who have cancer, TFMP are thought to be generated from cancer cells and may represent a risk factor for deep vein thrombosis. Enoxaparin has been used to prevent formation of blood clots in patients after abdominal or orthopedic surgery and in patients who suffer from a severe medical illness. Based on these studies, we are investigating to see if it prevents thrombosis in people with certain types of cancer.

A Pilot Study Comparing Enoxaparin to Fondaparinux to Prevent Venous Thromboembolism (VTE) in Bariatric Surgical Patients [Recruiting]
This pilot study is designed to determine the feasibility of conducting a randomized clinical trial comparing fondaparinux sodium (Arixtra) once daily with enoxaparin (Lovenox) twice daily with respect to preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) after bariatric surgery in obese patients.

Dose Adjusting Enoxaparin Thromboprophylaxis Dosage According to Anti-factor Xa Plasma Levels Improve Pregnancy Outcome [Recruiting]
The risk of venous thromboembolism increases in pregnancy. Thrombophilia whether genetic or acquired, is a hypercoagulable disorder that may increase the risk of venous thromboembolic events. Clinically, these events are presented as maternal deep vein thrombosis and pulmonary emboli. Thrombophilias are also associated with adverse fetal outcomes including intrauterine growth restriction, intrauterine fetal death, severe preeclampsia, placental abruption and recurrent abortions. Pregnant women who experienced one or more of the above complications are advised to be examined for the presence of the genetic or the acquired form of thrombophilia. Low molecular weight heparin prophylaxis, an anticoagulant, is advised for pregnant women with a history of thromboembolism, and many experts recommend prophylaxis for pregnant patients with a known thrombophilia and history of adverse pregnancy outcomes associated with these hypercoagulable states. Physiologic changes in normal pregnancy, including weight gain, increased renal clearance and volume of distribution, may decrease the availability of low molecular weight heparin (Enoxaparin or Dalteparin), or produce a less predictable response in pregnant women compared with nonpregnant women. There are no clear recommendations for use of prophylactic low molecular weight heparin in pregnancy. Clinicians tend to use doses suggested for nonpregnant patients. Regarding pregnant patients taking enoxaparin or dalteparin, the American College of Obstetricians and Gynecologists states that "because of the lack of data regarding adequate dosing during pregnancy, anti-factor Xa levels may be monitored". Two recently published studies demonstrated that plasma anti-factor Xa levels during pregnancy were lower than expected, indicating that many pregnant patients may receive a subprophylactic dosing. Our objective is to check pregnancy outcome among thrombophilic women treated with an adjusted enoxaparin thromboprophylaxis dosage according to anti-factor Xa plasma levels compared to women with fixed dosage.

more trials >>

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 >>


PATIENT REVIEWS / RATINGS / COMMENTS

Based 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.

 

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.

See all Lovenox reviews / ratings >>

Page last updated: 2014-12-10

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