Enoxaparin "Clexane

dr.joan

Enoxaparin "Clexane ' :
Trade name: Lovenox

Drug classes

· Low-molecular-weight heparin
· Antithrombotic agent
Pregnancy: (Category

Therapeutic actions

Low molecular weight heparin that inhibits thrombus and clot formation by blocking factor Xa, factor IIa, preventing the formation of clots.

Indications

· Prevention of deep vein thrombosis, which may lead to pulmonary embolism following hip replacement, knee replacement surgery, abdominal surgery
· Prevention of ischemic complications of unstable angina and non---Q-wave MI
· Treatment of deep vein thrombosis (DVT), pulmonary embolus with warfarin

Contraindications/cautions

· Contraindications: hypersensitivity to enoxaparin, heparin, pork products; severe thrombocytopenia; uncontrolled bleeding.
· Use cautiously with pregnancy or lactation, history of GI bleeding.
Dose
Prophylaxis of deep-vein thrombosis in medical patients, by subcutaneous injection, 40 mg (4000 units) every 24 hours for at least 6 days until patient ambulant (max. 14 days)
Treatment of deep-vein thrombosis or pulmonary embolism, by subcutaneous injection, 1.5 mg/kg (150 units/kg) every 24 hours, usually for at least 5 days (and until adequate oral anticoagulation established)
Unstable angina and non-ST-segment-elevation myocardial infarction, by subcutaneous injection, 1 mg/kg (100 units/kg) every 12 hours usually for 2–8 days (minimum 2 days)
Adverse effects

• Hematologic: Hemorrhage; bruising; thrombocytopenia; elevated AST, ALT levels; hyperkalemia
• Hypersensitivity: Chills, fever, urticaria, asthma
• Other: Fever; pain; local irritation, hematoma, erythema at site of injection

Clinically important interactions

• Drug-drug

v Increased bleeding tendencies with oral anticoagulants, salicylates, penicillins, cephalosporins

• Drug-lab test

v Increased AST, ALT levels

• Drug-alternative therapy

v Increased risk of bleeding if combined with chamomile, garlic, ginger, gingko, and ginseng therapy
Nursing Considerations

• Give drug as soon as possible after hip surgery.
• Give deep SC injections; do not give enoxaparin by IM injection.
• Administer by deep SC injection; patient should be lying down. Alternate between the left and right anterolateral and posterolateral abdominal wall. Introduce the whole length of the needle into a skin fold held between the thumb and forefinger; hold the skin fold throughout the injection.
• Apply pressure to all injection sites after needle is withdrawn; inspect injection sites for signs of hematoma; do not massage injection sites.
• Do not mix with other injections or infusions.
• Store at room temperature; fluid should be clear, colorless to pale yellow.
• Provide for safety measures (electric razor, soft toothbrush) to prevent injury to patient who is at risk for bleeding.
• Check patient for signs of bleeding; monitor blood tests.
• Alert all health care providers that patient is on enoxaparin.
• Discontinue and initiate appropriate therapy if thromboembolic episode occurs despite enoxaparin therapy.
• Have protamine sulfate (enoxaparin antidote) on standby in case of overdose.

Treat overdose as follows: Protamine sulfate (1% solution). Each mg of protamine neutralizes 1 mg enoxaparin. Give very slowly IV over 10 min.