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 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.
Media Articles Related to Lovenox (Enoxaparin)
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
Missed Doses Cripple Postop DVT Prevention
Source: MedPage Today Cardiovascular [2014.04.17]
(MedPage Today) -- Missed doses of prophylactic anticoagulation account for much of the deep vein thrombosis that occurs in surgery and trauma patients, a study showed.
NSAIDs Double Bleeding Risk With Anticoagulants for DVT/PE
Source: theheart.org | Medscape Cardiology Headlines [2014.04.15]
Patients taking anticoagulants for deep vein thrombosis or pulmonary embolism should not take NSAIDs or aspirin for pain and should instead reach for acetaminophen, researchers caution.
After joint replacement surgery, statins may lower blood clot risk
Source: Statins News From Medical News Today [2014.03.12]
Statins have long been known to lower cholesterol and, more recently, to decrease the risk of deep vein thrombosis (blood clots) in healthy, non-surgical patients.
Published Studies Related to Lovenox (Enoxaparin)
Impact of stageÂ 3B chronic kidney disease on thrombosis and bleeding outcomes
after orthopedic surgery in patients treated with desirudin or enoxaparin:
insights from a randomized trial. 
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. 
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.
Oral dabigatran versus enoxaparin for thromboprophylaxis after primary total hip arthroplasty (RE-NOVATE II*). A randomised, double-blind, non-inferiority trial. [2011.04]
This trial compared the efficacy and safety of oral dabigatran, a direct thrombin inhibitor, versus subcutaneous enoxaparin for extended thromboprophylaxis in patients undergoing total hip arthroplasty. A total of 2,055 patients were randomised to 28-35 days treatment with oral dabigatran, 220 mg once-daily, starting with a half-dose 1-4 hours after surgery, or subcutaneous enoxaparin 40 mg once-daily, starting the evening before surgery...
Clinical Trials Related to Lovenox (Enoxaparin)
Efficacy and Safety of the LovenoxTM (Enoxaparin) Versus HeparinTM Gynecologic Oncology Patients [Recruiting]
Prophylactic treatment will start from surgery until the patients are discharged from the
hospital(18). Then each patient will have 2 follow up visit in gyne- oncology clinic. The
first visit will be 2 weeks from discharge & the second visit will be 3 months after
surgery. In each visit patient will be evaluated for any evidence of thrombo-embolic events
clinically & radiologically if needed ( spiral CT, V/Q scan & lower limp Doppler ). Any side
effect or adverse reaction will be reported & it will be evaluated if it is related to the
drug used or not.
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.
Prophylactic Use of Sodium Enoxaparin for Venous Thromboembolism in High-Risk Abdominal Surgery [Not yet recruiting]
The purpose of this study is to compare the safety and security and efficacy of sodium
enoxaparin Cristália Produtos Químicos Farmaceuticos Ltda - Endorcris with Clexane
(Sanofi-Aventis) to prevent Venous Thromboembolism in Patients With High-Risk to Develop
Thromboembolic Disease Undergoing Geral Abdominal Surgery.
Comparison of Anti-Xa Activity of ENOXA ï¿½ Versus LOVENOX ï¿½ 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
Prevention of Maternal and Perinatal Complications by Enoxaparin in Women With Previous Severe Preeclampsia [Recruiting]
Preeclampsia (PE) complicates 2-8% of pregnancies. It is associated with an increased risk
of adverse maternal (death, eclampsia, abruptio placenta, HELLP syndrome) and perinatal
(perinatal death, growth restriction, prematurity) outcomes. The only definite treatment of
PE remains pregnancy termination. Therefore, prevention of PE remains an important
challenge. Low dose aspirin may be used in the prevention of PE, particularly in women who
had a severe preeclampsia before 34 weeks. Its efficiency, however, is very weak. Recently,
it has been suggested that low molecular weight heparin might be useful in the prevention of
The aim of this study is to analyze the usefulness of the enoxaparin 4000 UI/day in the
prevention of a composite maternal or perinatal morbidity (occurrence of one of the
following events: maternal death, PE, fetal growth retardation, abruptio placenta, perinatal
death) in women who previously had a severe preeclampsia at less than 34 weeks' gestation.
To answer this question, the investigators propose to conduct a multicenter prospective
randomized trial that will compare two groups in parallel: a group where women will have an
association of enoxaparin 4000 U/day and aspirin 100 mg/day and another group where women
would have only aspirin 100 mg/day. The number of patients needed in each arm is 220.
Reports of Suspected Lovenox (Enoxaparin) Side Effects
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
|Overall rating:|| || |
|Effectiveness:|| || Highly Effective|
|Side effects:|| || Mild Side Effects|
|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|
|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
|Overall rating:|| || |
|Effectiveness:|| || Highly Effective|
|Side effects:|| || No Side Effects|
|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|
|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. |
Page last updated: 2014-04-17