Enoxaparin Brand Name– Lovenox
What is Enoxaparin
Enoxaparin is a low molecular weight heparin (LMWH) used for prophylaxis and management of systemic thromboembolism, including deep venous thrombosis and pulmonary embolism, and treatment of acute ST-segment elevation myocardial infarction (STEMI).
Enoxaparin is produced through partial depolymerization of porcine mucosal heparin. While unfractionated heparin (UFH) contains molecules ranging from 3,000 to 30,000 (mean 15,000) daltons, enoxaparin molecules are 2,000 to 8,000 daltons (average 4,500 daltons).
Enoxaparin and other low molecular weight heparins produce a more predictable anticoagulant response than UFH, reflecting their better bioavailability after subcutaneous injection, longer half-life, and dose-independent clearance.
The risk of adverse reactions associated with heparin use, such as heparin-induced thrombocytopenia (HIT) and osteoporosis, also appear to be reduced with enoxaparin compared to UFH.
The anticoagulant effects of enoxaparin are also less likely to be influenced by other drugs or diet compared to oral anticoagulants, such as warfarin.
Enoxaparin was FDA-approved in March 1993
Indications
- acute myocardial infarction
- antiphospholipid antibody syndrome
- arterial thromboembolism prophylaxis
- cerebral thromboembolism
- coronary artery thrombosis prophylaxis
- deep venous thrombosis (DVT)
- deep venous thrombosis (DVT) prophylaxis
- percutaneous coronary intervention (PCI)
- periprocedural anticoagulation
- pulmonary embolism
- pulmonary embolism prophylaxis
- thrombosis prophylaxis
- unstable angina
For the treatment of venous thromboembolism (VTE) including acute deep venous thrombosis (DVT) or pulmonary embolism (PE)
for inpatient treatment of DVT with or without PE
Side Effects
- alopecia
- anaphylactic shock
- anaphylactoid reactions
- anemia
- atrial fibrillation
- bleeding
- bullous rash
- cholestasis
- confusion
- diarrhea
- disseminated intravascular coagulation (DIC)
- dyspnea
- ecchymosis
- edema
- elevated hepatic enzymes
- eosinophilia
- erythema
- fetal death
- fever
- headache
- heart failure
- hematoma
- hematuria
- hyperkalemia
- hyperlipidemia
- hypertriglyceridemia
- injection site reaction
- intracranial bleeding
- nausea
- ocular hemorrhage
- osteoporosis
- peripheral edema
- pruritus
- pulmonary edema
- purpura
- retroperitoneal bleeding
- skin necrosis
- spinal hematoma
- thrombocytopenia
- thrombocytosis
- thrombosis
- urticaria
- vasculitis
- vesicular rash
Monitoring Parameters
- anti-Xa activity
- CBC
- serum creatinine
- stool guaiac
- urinalysis
Contraindications
- aneurysm
- anticoagulant therapy
- benzyl alcohol hypersensitivity
- bleeding
- breast-feeding
- coagulopathy
- diabetic retinopathy
- dialysis
- diverticulitis
- endocarditis
- epidural anesthesia
- geriatric
- GI bleeding
- hemophilia
- heparin hypersensitivity
- heparin-induced thrombocytopenia (HIT)
- hepatic disease
- hypertension
- immune thrombocytopenic purpura (ITP)
- infants
- inflammatory bowel disease
- intramuscular injections
- lumbar puncture
- neonates
- obesity
- peptic ulcer disease
- porcine protein hypersensitivity
- pregnancy
- prosthetic heart valves
- renal disease
- renal failure
- renal impairment
- spinal anesthesia
- stroke
- surgery
- thrombocytopenia
- thrombolytic therapy
Interactions
- Abciximab
- Ado-Trastuzumab emtansine
- Alteplase
- Altretamine
- Amlodipine; Celecoxib
- Anagrelide
- Antithrombin III
- Antithymocyte Globulin
- Apixaban
- Argatroban
- Arsenic Trioxide
- Aspirin, ASA; Dipyridamole
- Betrixaban
- Bivalirudin
- Caplacizumab
- Carbenicillin
- Celecoxib
- Chlorambucil
- Cilostazol
- Clofarabine
- Clopidogrel
- Collagenase
- Cytarabine, ARA-C
- Dabigatran
- Dalteparin
- Danaparoid
- Danazol
- Dasatinib
- Decitabine
- Deferasirox
- Defibrotide
- Denileukin Diftitox
- Desirudin
- Dextran
- Diclofenac
- Diclofenac; Misoprostol
- Diflunisal
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Dipyridamole
- Drotrecogin Alfa
- Edoxaban
- Eltrombopag
- Epoprostenol
- Eptifibatide
- Esomeprazole; Naproxen
- Esterified Estrogens; Methyltestosterone
- Estramustine
- Etodolac
- Famotidine; Ibuprofen
- Fenoprofen
- Fish Oil, Omega-3 Fatty Acids (Dietary Supplements)
- Floxuridine
- Fluorouracil, 5-FU
- Flurbiprofen
- Folate analogs
- Fondaparinux
- Garlic, Allium sativum
- Ginger, Zingiber officinale
- Ginkgo, Ginkgo biloba
- Green Tea
- Hemin
- Heparin
- Hydrochlorothiazide, HCTZ; Spironolactone
- Hydrocodone; Ibuprofen
- Hydroxyurea
- Ibritumomab Tiuxetan
- Ibrutinib
- Ibuprofen
- Ibuprofen; Oxycodone
- Ibuprofen; Pseudoephedrine
- Icosapent ethyl
- Iloprost
- Imatinib
- Indomethacin
- Inotersen
- Interferon Alfa-2a
- Interferon Alfa-2b
- Interferon Alfa-2b; Ribavirin
- Interferon Alfa-n3
- Interferon Alfacon-1
- Intravenous Lipid Emulsions
- Ketoprofen
- Ketorolac
- Lansoprazole; Naproxen
- Lepirudin
- Lomustine, CCNU
- Meclofenamate Sodium
- Mefenamic Acid
- Meloxicam
- Methoxsalen
- Methylsulfonylmethane, MSM
- Methyltestosterone
- Mifepristone
- Miltefosine
- Mycophenolate
- Nabumetone
- Nandrolone Decanoate
- Naproxen
- Naproxen; Pseudoephedrine
- Naproxen; Sumatriptan
- Natural Antineoplastics
- Nelarabine
- Nintedanib
- Nonsteroidal antiinflammatory drugs
- Obinutuzumab
- Omacetaxine
- Orlistat
- Oxandrolone
- Oxaprozin
- Palifermin
- Pentosan
- Phentermine; Topiramate
- Pimozide
- Piperacillin
- Piperacillin; Tazobactam
- Piroxicam
- Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements)
- Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved)
- Prasugrel
- Reteplase, r-PA
- Rivaroxaban
- Rofecoxib
- Salicylates
- Selective serotonin reuptake inhibitors
- Serotonin norepinephrine reuptake inhibitors
- Sodium Hyaluronate, Hyaluronic Acid
- Sodium Iodide
- Spironolactone
- Streptokinase
- Sulfinpyrazone
- Sulindac
- Telavancin
- Tenecteplase
- Thrombolytic Agents
- Ticagrelor
- Ticarcillin
- Ticarcillin; Clavulanic Acid
- Ticlopidine
- Tinzaparin
- Tipranavir
- Tirofiban
- Tolmetin
- Topiramate
- Trazodone
- Treprostinil
- Tretinoin, ATRA
- Urokinase
- Valdecoxib
- Verteporfin
- Vilazodone
- Vorapaxar
- Vorinostat
- Vortioxetine
- Warfarin
