Lovenox

Lovenox is an antithrombotic drug that alters the body’s ability to clot, preventing angerous clots from forming. The ability of Lovenox to prevent clotting is due to its ability to inhibit factor Xa resulting in decreased thrombin and ultimately the prevention of fibrin clot formation. Lovenox is used to treat unstable angina, Non-ST elevated myocardial infarction (NSTEMI) and ST elevated Myocardial Infarction (STEMI), Prophylactically following hip, knee or abdominal surgery or in those patients with severely restricted mobility in a hospital setting. It is also used to treat acute deep vein thrombosis (DVT) as inpatient for those with or without a pulmonary embolus.



Contraindications and Guidelines for Lovenox

Lovenox is contraindicated in patients with a history of aneurysm, cerebral vascular accident (CVA or stroke,) epidural punctures, uncontrolled hypertension, or women with a threatened abortion. Lovenox should be used cautiously in patients with a history of Heparin Induced thrombocytopenia (HIT). Dosing can be based on mg/Kg in patients with DVT, USA, or non-Q wave MI or a standard dose of 30 or 40mg subcutaneously every day for other indications. Dosages must be adjusted for patients with renal impairment. Side effects of Lovenox mainly relate to its inhibition of Xa resulting in spontaneous bleeding such as nosebleeds, bleeding gums coughing or vomiting blood or unexplained bruising. Other side effects include dizziness, rapid heart beat, chest pain shortness of breath, nausea,vomiting or confusion.

Is Death From A Pulomonary Embolus Preventable?

“Pulmonary embolism remains the most common preventable cause of death in hospitals.” (Morrell MT and Dunhill MS (1968) Br Surg 55, 347-352.)

It is estimated that 1 in every 100 patients will die from a pulmonary embolism (PE) giving prophylactic Lovenox could prevent many of these deaths. Patients taking a daily aspirin may not be completely safe from a dangerous blood clot while in the hospital. When patients are admitted they are evaluated based on their risk of developing a Deep vein thrombosis (DVT) or PE. Based on individual risk factors these patients are then placed on prophylactic Lovenox or Heparin subcutaneous (SQ). Patients who are at high risk for bleeding received sequential compression devices (SCD’s) or TED hose. Very high-risk patients, patients with multiple trauma, acute spinal cord injuries, or major hip, pelvis, or leg fractures. Patients admitted with myocardial infarction, congestive heart failure, severe lung disease, cancer, patients older than 75, or have a personal history of DVT are considered high risk. Moderate risk patients, are those with general medical illnesses, minor surgery, estrogen replacement therapy or pregnant women. These patients are then placed on Lovenox or Heparin based on hospital guidelines for prevention of DVT and PE’s. All low risk patients are encouraged to ambulate early and often and usually do not receive prophylactic anticoagulants. Of course there are also contraindications that the prescriber must also be careful of such as any bleeding disorder or HIT antibody positive.

The concern for patients devoloping a blood clot is not relagated to hospital stays only. This short video describes how lovenox is prescribed for high risk patients after their discharge from the hospital.

http://www.outcomes-umassmed.org/dvt/best_practice/

http://Lovenox.com/consumer/default.aspx

Galson,S. (2008). Surgeon General’s Perspectives:Prevention of deep vein thrombosis and pulmonary embolism. Public Health Reports, 123, 420-421. Retrieved http://www.publichealthreports.org/

Schilling McCaan, J.A. (2009) Nursing 2009 Drug handbook. New York: Wolters Kluwer/Lippincott Williams & Wilkins.

Tarrant County Hospital District (2008) DVT prophylaxis Order Set.