From the FDA Drug Label
Switching from apixaban to anticoagulants other than warfarin (oral or parenteral): Discontinue apixaban and begin taking the new anticoagulant other than warfarin at the usual time of the next dose of apixaban
The proper protocol to switch from Eliquis (apixaban) to Lovenox (enoxaparin) is to discontinue apixaban and begin taking Lovenox at the usual time of the next dose of apixaban 1.
From the Research
Switching from Eliquis (apixaban) to Lovenox (enoxaparin) should be done under medical supervision, as the timing is critical to maintain proper anticoagulation, and the recommended approach is to stop taking Eliquis and begin Lovenox 12 hours after the last Eliquis dose, with Lovenox administered as a subcutaneous injection, typically once or twice daily depending on the condition and weight, at a standard therapeutic dose often of 1 mg/kg twice daily or 1.5 mg/kg once daily, as determined by the doctor 2, 3.
Key Considerations
- The transition from Eliquis to Lovenox is necessary because Eliquis is an oral direct factor Xa inhibitor, while Lovenox is an injectable low molecular weight heparin that works slightly differently in the coagulation cascade.
- Common reasons for switching include upcoming surgery, kidney function changes, or pregnancy.
- Lovenox requires monitoring of anti-Xa levels in certain situations, and patients should watch for signs of bleeding or bruising during the transition period.
- The dosage of Lovenox may need to be adjusted based on the patient's weight and kidney function, with a reduced dose recommended for patients with severe renal failure, as shown in a study where enoxaparin 1 mg/kg subcutaneously once every 24 hours was safe and effective in patients with stage 4 or 5 chronic kidney disease 4.
Administration and Monitoring
- Lovenox is administered as a subcutaneous injection, and patients should learn proper injection technique, including rotating injection sites between areas like the abdomen, thighs, or upper arms.
- The standard therapeutic dose of Lovenox is often 1 mg/kg twice daily or 1.5 mg/kg once daily, but the doctor will determine the exact dosage for the patient's situation.
- Monitoring of anti-Xa levels is important in certain situations, such as in patients with renal dysfunction or obesity, to ensure that the patient is receiving the correct dose of Lovenox and to minimize the risk of bleeding or other complications, as discussed in a study that evaluated the safety and efficacy of enoxaparin in patients with severe renal failure 4.
Special Considerations
- In patients with severe renal failure, the dose of Lovenox may need to be reduced to 1 mg/kg subcutaneously once every 24 hours, as shown in a study that evaluated the safety and efficacy of enoxaparin in patients with stage 4 or 5 chronic kidney disease 4.
- In obese patients, the dose of Lovenox should be based on total body weight, and antifactor Xa levels should be monitored to ensure that the patient is receiving the correct dose, as discussed in a study that evaluated the use of low-molecular-weight heparin in obese patients and patients with renal dysfunction 5.