From the Research
Restarting Lovenox (Enoxaparin) Postpartum
- The decision to restart Lovenox (enoxaparin) in a postpartum patient 8 hours after vaginal delivery depends on various factors, including the patient's risk of venous thromboembolism (VTE) and bleeding complications.
- A study published in 2008 1 found that the timing of postpartum enoxaparin administration did not significantly influence hemorrhagic outcomes, and that severe postpartum hemorrhage was an infrequent complication when enoxaparin was administered to hemostatically intact women between 5 and 24 hours following a vaginal delivery.
- Another study published in 2015 2 administered the first dose of enoxaparin 6 hours after vaginal delivery, or 8 hours after delivery in women receiving spinal anesthesia, and found that enoxaparin was effective in reducing the incidence of VTE.
- A study published in 2005 3 found that discontinuing low molecular weight heparin (LMWH) more than 12 hours before delivery was safe in relation to maternal hemorrhagic complications.
- A study published in 2019 4 reported a low rate of breakthrough VTE in women who received extended thromboprophylaxis with enoxaparin, but also reported high rates of postpartum hemorrhage.
- A recent study published in 2023 5 compared two weight-based protocols for enoxaparin administration and found that administering enoxaparin at 1 mg/kg once daily was superior to weight categories in reaching anti-Xa prophylactic levels without leading to serious adverse effects.
Key Considerations
- The American College of Obstetricians and Gynecologists (ACOG) recommends that women at high risk of VTE receive thromboprophylaxis with LMWH, such as enoxaparin, during the postpartum period.
- The timing and dosage of enoxaparin administration should be individualized based on the patient's risk factors and medical history.
- Close monitoring of the patient's anti-Xa levels and bleeding complications is essential to ensure the safe and effective use of enoxaparin.