From the Guidelines
Therapeutic Lovenox (enoxaparin) should be used at a dose of 1 mg/kg subcutaneously every 12 hours or 1.5 mg/kg once daily for the treatment of deep vein thrombosis (DVT) or pulmonary embolism (PE) in patients with cancer, as recommended by the NCCN guidelines 1.
Key Considerations
- The dose of enoxaparin may need to be adjusted in patients with severe renal impairment (CrCl <30 mL/min) to 1 mg/kg subcutaneously every 24 hours 1.
- Monitoring of anti-Xa levels is recommended in special populations, such as patients with renal impairment, to ensure therapeutic levels are achieved 1.
- Enoxaparin has been shown to be effective in preventing recurrent VTE in patients with cancer, with a lower incidence of VTE compared to oral vitamin K antagonists 1.
Special Populations
- Patients with severe renal impairment (CrCl <30 mL/min): dose adjustment to 1 mg/kg subcutaneously every 24 hours 1.
- Obese patients (body mass index >30 kg/m2): caution should be used when administering enoxaparin, and dose adjustments may be necessary 1.
- Elderly patients (≥70 years of age): caution should be used when administering enoxaparin, and dose adjustments may be necessary 1.
Mechanism of Action
- Enoxaparin works by binding to antithrombin, enhancing its inhibition of coagulation factors Xa and IIa, thereby preventing clot formation and extension 1.
Common Side Effects
- Bleeding, bruising at injection sites, and rarely, heparin-induced thrombocytopenia 1.
From the Research
Therapeutic Lovenox
Therapeutic Lovenox, also known as enoxaparin, is a low molecular weight heparin used to prevent and treat deep vein thrombosis and pulmonary embolism. The following are some key points about therapeutic Lovenox:
- Enoxaparin is used in various medical conditions, including venous thromboembolism prophylaxis in renally impaired ICU patients 2.
- The efficacy and safety of enoxaparin have been compared to other anticoagulants, such as unfractionated heparin (UFH) and fondaparinux, in different patient populations 2, 3.
- Enoxaparin has been shown to be effective in preventing portal vein thrombosis in cirrhotic patients with hepatitis B, with a dose of 1 mg/kg subcutaneously every 12 hours being a better anticoagulation regimen 4.
- The use of enoxaparin as an anticoagulant for continuous venovenous hemodialysis has been compared to UFH, with enoxaparin being associated with an increased rate of bleeding 5.
- Enoxaparin has been compared to warfarin for the prevention of left ventricular mural thrombus after anterior wall acute myocardial infarction, with enoxaparin tending to shorten hospitalization and lower cost of care 6.
Indications and Usage
The indications and usage of therapeutic Lovenox include:
- Venous thromboembolism prophylaxis in renally impaired ICU patients 2
- Treatment of portal vein thrombosis in cirrhotic patients with hepatitis B 4
- Anticoagulation for continuous venovenous hemodialysis 5
- Prevention of left ventricular mural thrombus after anterior wall acute myocardial infarction 6
Safety and Efficacy
The safety and efficacy of therapeutic Lovenox have been evaluated in various studies, including:
- A study comparing enoxaparin to UFH in renally impaired ICU patients, which found that enoxaparin was associated with an increased risk of major bleeding 2
- A study comparing enoxaparin to fondaparinux in patients with non-ST-segment elevation acute coronary syndromes, which found that fondaparinux was associated with lower rates of major bleeding 3
- A study evaluating the efficacy and safety of enoxaparin in cirrhotic patients with hepatitis B, which found that enoxaparin was effective in preventing portal vein thrombosis with a low risk of bleeding 4