MASSACHUSETTS GENERAL HOSPITAL

Department of Pharmacy

Department of Nursing

Critical Care

Generic Name:	Enoxaparin
Trade Name:	Lovenox
Action:	Anticoagulant Inhibit factor Xa
Indications:	Prophylaxis of DVT Treatment of DVT with or without pulmonary embolism Unstable angina/ Non-ST elevation MI (UA/NSTEMI) Acute ST segment elevation myocardial infarction (STEMI)
Administration Guidelines:
Usual Dose and Route:	DVT prophylaxis: High risk: 30mg SC BID Low risk: 40mg SC QD DVT/PE treatment: 1mg/kg SC Q12H Unstable angina/NSTEMI: Initial 30mg IV push (optional) followed by; 1mg/kg SC Q12H Percutaneous coronary intervention (PCI): Based on previous enoxaparin administration Prior Enoxaparin administration ³2 doses of SC or 30 mg IV bolus + 1 SC dose · If the last SC dose of Enoxaparin was given 8 hours or greater, administer an additional 0.3 mg/kg IV push. · If the last SC dose of Enoxaparin was given less than 8 hours ago, do not administer any additional doses. 1 dose of SC with no IV bolus dose · Additional 0.3 mg/kg IV bolus at the time of PCI No Prior Enoxaparin administration ·     With or without concurrent Glycoprotein IIb/IIIa inhibitors         0.5 - 0.75 mg/kg IV push STEMI: (maximum of 8 days) < 75 years: 30mg IV bolus followed by 1mg/kg SC Q12H (Maximum 100mg for first 2 SC doses) > 75 years: 0.75mg/kg SC Q12H (Maximum 75mg/dose for first 2 SC doses) Enoxaparin dosing according to renal function: Not recommended in acute renal failure, ESRD or dialysis CrCl <30 mL/minute: DVT prophylaxis in abdominal surgery, hip replacement, knee replacement, or in medical patients during acute illness: 30 mg once daily DVT treatment (inpatient or outpatient treatment in conjunction with warfarin): 1 mg/kg once daily STEMI, Unstable angina, NSTEMI: 1 mg/kg once daily
Standard Concentration:	Prefilled syringes: - 30 mg / 0.3 mL, 40 mg / 0.4 mL, 60 mg / 0.6 mL, 80 mg / 0.8 mL, 100mg / 1 mL, 120mg / 0.8mL,150mg / 1 mL MDV: 300mg/3mL
Special Considerations:	Does not significantly prolong the PTT or PT Consult hematology for dosing during pregnancy Overdose/hemorrhagic complications: Protamine sulfate: partial reversal ~55% of anti-Xa activity 1 mg protamine IV for every 1 mg of enoxaparin. A second infusion of 0.5 mg protamine for every 1 mg enoxaparin may be administered 2-4 hours after first infusion of protamine. Refer to Protamine monograph for administration information Monitoring: Routine monitoring is not recommended Consider monitoring anti-Xa activity in pediatrics, renal dysfunction and pregnancy Obtain anti-Xa levels (haparin level) 4 hours after a SC dose Consult hematology for monitoring and dosage adjustments based on anti-Xa levels Converting from IV Heparin infusion to Enoxaparin: Stop Heparin infusion Wait 0-60 minutes. If PTT is > 100 may consider 90 minutes if necessary. Then give Enoxaparin dose. Converting from Enoxaparin to IV Heparin infusion: IV Heparin infusion may be initiated 12 hours after last Enoxaparin dose.
Precautions and Side Effects:	- Hemorrhage, bleeding from iv sites - HIT -Increased risk of bleeding in patients on coumadin, aspirin, ticlopidine or plavix -Epidural and Spinal anesthesia

Revised 11/30/2006