From the Guidelines
Lovenox (enoxaparin) should typically be held 12 hours before surgery for most non-high bleeding risk procedures, and 24 hours for therapeutic doses or high bleeding risk procedures, considering its half-life of approximately 4-7 hours in patients with normal kidney function 1. The half-life of Lovenox is approximately 4-7 hours in patients with normal kidney function, but can extend to 7-12 hours in those with renal impairment.
Key Considerations
- For most non-high bleeding risk procedures, holding the last prophylactic dose (40mg daily) 12 hours before surgery is sufficient.
- For therapeutic doses (1mg/kg twice daily or 1.5mg/kg daily), a longer interval of 24 hours is generally recommended.
- High bleeding risk procedures may require holding Lovenox for a full 24 hours regardless of dosing.
- Patients with severe renal impairment (creatinine clearance <30 mL/min) need longer holding periods as the medication clears more slowly from their system. Some important points to consider when managing Lovenox in the perioperative period include:
- The timing of Lovenox administration and surgery should be individualized based on the specific procedure and patient factors.
- Resumption of Lovenox typically occurs 24 hours after surgery when hemostasis is established, but this should be individualized based on the specific procedure and patient factors 1.
Patient-Specific Factors
- Renal function: patients with severe renal impairment may require longer holding periods.
- Bleeding risk: high bleeding risk procedures may require longer holding periods.
- Type of surgery: the type of surgery and the patient's individual risk factors should be taken into account when determining the timing of Lovenox administration and surgery. It is essential to weigh the risks of thrombotic events against the risks of bleeding when making decisions about Lovenox administration in the perioperative period, as stated in the guidelines 1.
From the Research
Half Life of Lovenox
- The half-life of Lovenox (enoxaparin) is not explicitly stated in the provided studies.
- However, it is known that the half-life of enoxaparin is approximately 4-6 hours in patients with normal renal function 2.
Holding Lovenox Before Surgery
- The American Society of Regional Anesthesia recommends stopping enoxaparin at least 12 hours before surgery, and possibly longer in patients with renal insufficiency 2.
- One study suggests stopping enoxaparin at least 12 hours before surgery and resuming it once hemostasis is achieved, usually within 24 hours 2.
- Another study used a protocol where warfarin was discontinued 5 days before surgery, and enoxaparin was administered twice daily by subcutaneous injection at a dose of 1 mg per kg from 3 days before the procedure to the last dose 24 hours before the procedure 3.
- It is essential to note that the optimal timing for holding Lovenox before surgery may vary depending on the patient's renal function, the type of surgery, and other individual factors, and should be determined on a case-by-case basis 4, 5, 6.