From the Guidelines
Lovenox (enoxaparin) is contraindicated in patients with active major bleeding, a history of immune-mediated heparin-induced thrombocytopenia, hypersensitivity to enoxaparin or its components, and severe renal impairment (creatinine clearance <30 mL/min). According to the most recent and highest quality study 1, patients with severe renal impairment require dose adjustment or alternative therapy due to increased bleeding risk from drug accumulation. Other relative contraindications include uncontrolled severe hypertension, diabetic or hemorrhagic retinopathy, recent brain, spinal, or ophthalmological surgery, and concurrent use of other anticoagulants.
Key Contraindications
- Active major bleeding
- History of immune-mediated heparin-induced thrombocytopenia
- Hypersensitivity to enoxaparin or its components
- Severe renal impairment (creatinine clearance <30 mL/min)
Special Considerations
- Recent lumbar puncture, spinal anesthesia, or epidural catheter placement
- Uncontrolled severe hypertension
- Diabetic or hemorrhagic retinopathy
- Recent brain, spinal, or ophthalmological surgery
- Concurrent use of other anticoagulants
- Pregnant women with mechanical heart valves may require alternative anticoagulation strategies due to reports of valve thrombosis with Lovenox, as noted in 1 and 1.
Dosing Adjustments
- Patients with severe renal impairment (creatinine clearance <30 mL/min) may require dose adjustment or alternative therapy, as recommended in 1 and 1. It is essential to carefully evaluate the risks and benefits of using Lovenox in patients with these conditions and to consider alternative anticoagulation strategies when necessary.
From the Research
Contraindications for Lovenox
- Severe thrombocytopenia is a potential contraindication for Lovenox, although a study from 2 suggests that reduced dosages of low molecular weight heparins may be used relatively safely during transient severe thrombocytopenia.
- Heparin-induced thrombocytopenia (HIT) is a severe side effect of heparin administration, including Lovenox, as reported in cases 3 and 4.
- Patients with a history of HIT or those who develop thrombocytopenia while on Lovenox therapy should have the medication discontinued and alternative treatments considered, such as fondaparinux 3.
- The presence of antibodies against heparin is a key factor in the diagnosis of HIT, as seen in the case reports 3 and 4.