From the Research
Restarting Lovenox (Enoxaparin) After Vaginal Delivery
- The appropriate time to restart anticoagulation with enoxaparin after vaginal delivery is not well established, but studies suggest it can be restarted within 24 hours after delivery 1.
- One study found that administering the first dose of enoxaparin less than 24 hours following vaginal delivery did not increase the risk of severe postpartum hemorrhage 1.
- Another study discontinued enoxaparin 12-24 hours before delivery and restarted it within 8-12 hours after delivery, with no significant differences in terms of therapy response, complications, and efficacy 2.
- A prospective clinical trial compared the ability of enoxaparin and bemiparin to decrease the incidence of venous thromboembolism following vaginal delivery, and found that the first dose was administered 6 hours after vaginal delivery, with subsequent doses administered daily for up to 6 days 3.
- A study assessing the safety of discontinuing low molecular weight heparin 12-24 hours before delivery found that discontinuing enoxaparin more than 12 hours before delivery was safe in relation to maternal hemorrhagic complications 4.
- A randomized controlled trial compared two weight-based protocols for enoxaparin administration after delivery, 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 5.
Key Findings
- Enoxaparin can be restarted within 24 hours after vaginal delivery 1, 2.
- The timing of postpartum enoxaparin administration does not appear to increase the risk of severe postpartum hemorrhage 1.
- Different weight-based protocols for enoxaparin administration may have varying efficacy and safety profiles 5.
- Enoxaparin administration at 1 mg/kg once daily may be the preferred protocol for postpartum venous thromboembolism prophylaxis 5.