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Lovenox, Enoxaparin Sodium (generic): Frequently Asked Questions

What is enoxaparin (Lovenox™)?

Patients undergoing a major orthopaedic surgery, such as knee or hip surgery, are at risk of deep vein thrombosis, which are blood clots. Enoxaparin (Lovenox™) is a drug to prevent blood clots from forming. Most patients will receive this drug after surgery for a brief period of time.

Why should I try Lovenox?

Lovenox has been proven to be as safe and effective as heparin in clinical trials. Lovenox has several advantages over heparin, including the fact that it has an indication for outpatient therapy and it does not require routine monitoring. Also, unlike heparin, Lovenox has excellent bioavailability, resulting in a predictable dose response. Finally, therapy with Lovenox is potentially less expensive than heparin therapy when all costs of monitoring and staff time are considered. Concurrent Therapy

How can/should treatment with Lovenox be monitored?

Lovenox does not require coagulation tests when recommended treatment doses are used. It has little effect on aPTT or PT. Only tests evaluating anti-Xa activity can be used (e.g., anti-Xa mucolytic assay or a chronometric test such as the Heptest). Periodic complete blood counts, including platelet count and stool occult blood tests, are recommended during the course of treatment with Lovenox.

What safety precautions are necessary with Lovenox treatment?

You should ensure that the injection technique is correct. Never administer Lovenox intramuscularly. Do not expel air bubbles from the syringe. Use extreme caution in patients with a history of heparin-induced thrombocytopenia. Remember that Lovenox is not interchangeable, unit for unit, with unfractionated heparin (UFH) or other LMWHs.

What if a patient suffers a thromboembolic event during Lovenox treatment?

If this occurs, Lovenox should be discontinued. The patient's condition needs to be reassessed in order to determine appropriate therapy. Laboratory Tests

How long should I continue treatment with Lovenox?

Treatment of DVT with or without PE with Lovenox should continue for a minimum of 5 days and until a therapeutic anticoagulant effect from warfarin has been achieved (International Normalization Ratio [INR] 2.0 to 3.0). The average duration of administration is 7 days, although up to 17 days of Lovenox therapy has been well tolerated in clinical trials. Safety

Why don't I have to monitor a patient's aPTT while they are on Lovenox?

At the recommended doses, single injections of enoxaparin do not significantly influence platelet aggregation or affect global clotting tests (i.e., prothrombin time [PT] or activated partial thromboplastin time [aPTT]). Therefore, these tests, are not useful in monitoring therapy with Lovenox. The major anticoagulant effect of the LMWHs is the accelerated inactivation of coagulation Factor Xa. ...

How can I be sure that Lovenox is safe and effective for outpatient treatment?

The safety and efficacy of Lovenox used in the outpatient treatment of DVT has been evaluated by clinical trials. A study by Levine and colleagues found that Lovenox provides efficacy and safety comparable to heparin in the hospital. In this randomized study, Lovenox administered twice a day at home was compared to heparin administered in the hospital. The incidence of recurrent thromboembolism within 90 days after the start of therapy was 5.3% in the Lovenox group compared to 6.7% in the heparin group. ...

Are there any special precautions that I should take when administering Lovenox?

You may notice a gas bubble in the prefilled Lovenox syringe. This gas bubble should not be expelled. The full length of the needle should be introduced vertically. Finally, the injected area should not be rubbed.

Can I use Lovenox for pregnant or nursing women?

Lovenox is in pregnancy category B meaning that studies in animals showed no evidence of teratogenicity or fetotoxicity. Lactating mothers should be cautioned when receiving Lovenox. Several small studies have shown that the use of LMWH in pregnant women was safe. However, there are no adequate and well controlled studies in this patient population.

How long will I have to take enoxaparin (Lovenox™) after surgery?

Length of enoxaparin treatment usually ranges from 10-21 days depending on the type of surgery and individual assessment is required to guide treatment duration. You will be informed of treatment duration during your hospital stay.

Do I have to worry about my patients developing thrombocytopenia in patients on Lovenox?

Lovenox is associated with a lower risk of immune sensitization and thrombocytopenia than heparin. However, it is possible for Lovenox to produce a positive in-vitro test for heparin induced thrombocytopenia (HIT) in patients with a history of HIT. Thrombocytopenia may occur in these patients. Warkentin et. al. conducted a large randomized clinical trial comparing the occurrence rate of thrombocytopenia between unfractionated heparin and Lovenox. ...

Can other drugs that require intramuscular injection be administered while patients are receiving Lovenox therapy?

Intramuscular injections are not recommended in patients receiving Lovenox.

How much will enoxaparin (Lovenox™) cost? What do I do if I can’t afford it?

Enoxaparin is paid for while you are receiving it during the Mount Sinai Hospital stay or any other rehabilitation facilities. If you are going home after discharge, you will have to cover the cost. For prevention of blood clots, it is not listed under Ontario Drug Benefit (ODB). This means that, if you have ODB coverage (if over age of 65) or social assistance or disability assistance, it will not be covered. Most private drug insurance companies do cover the cost of enoxaparin. Please call them to verify the coverage. ...

Is the Self-Administered Drugs list on your website complete? The drug Lovenox was previously on the list and now it is not. Does that mean the drug is now covered?

Yes the list is complete. Lovenox is not on the list because it is not considered to be a self-administered drug. Thus, Lovenox may be covered “incident to” physician services when reasonable and necessary usage is documented. Those medications listed on the SAD list are not covered “incident to” physician services because they meet the CMS guidelines for exclusion from payment as self-administered drugs. ...
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