Enoxaparin "Clexane ' : Commonly used drugs in Emergency & ICU

Enoxaparin  "Clexane ' 

         Trade name: Lovenox

        Drug classes

•       Low-molecular-weight heparin

•       Antithrombotic agent

Pregnancy: (Category B)

Therapeutic actions

Low molecular weight heparin that inhibits thrombus and clot formation by blocking factor Xa, factor IIa, preventing the formation of clots.

     Indications

•       Prevention of deep vein thrombosis, which may lead to pulmonary embolism following hip replacement, knee replacement surgery, abdominal surgery

•       Prevention of ischemic complications of unstable angina and non---Q-wave MI

•       Treatment of deep vein thrombosis (DVT), pulmonary embolus with warfarin

  Contraindications/cautions

•       Contraindications: hypersensitivity to enoxaparin, heparin, pork products; severe thrombocytopenia; uncontrolled bleeding.

•       Use cautiously with pregnancy or lactation, history of GI bleeding.

Dose

Prophylaxis of deep-vein thrombosis in medical patients, by subcutaneous injection, 40 mg

(4000 units) every 24 hours for at least 6 days until patient ambulant (max. 14 days)

Treatment of deep-vein thrombosis or pulmonary embolism, by subcutaneous injection, 1.5 mg/kg (150 units/kg) every 24 hours, usually for at least 5 days (and until adequate oral anticoagulation established)

Unstable angina and non-ST-segment-elevation myocardial infarction, by subcutaneous

injection, 1 mg/kg (100 units/kg) every 12 hours usually for 2–8 days (minimum 2 days) Adverse effects

•       Hematologic: Hemorrhage; bruising; thrombocytopenia; elevated AST, ALT levels; hyperkalemia

•       Hypersensitivity: Chills, fever, urticaria, asthma

•       Other: Fever; pain; local irritation, hematoma, erythema at site of injection

Clinically important interactions

•       Drug-drug

v  Increased bleeding tendencies with oral anticoagulants, salicylates, penicillins, cephalosporins

•       Drug-lab test

v  Increased AST, ALT levels

•       Drug-alternative therapy

v  Increased risk of bleeding if combined with chamomile, garlic, ginger, gingko, and ginseng therapy

Nursing Considerations

•       Give drug as soon as possible after hip surgery.

•       Give deep SC injections; do not give enoxaparin by IM injection.

•       Administer by deep SC injection; patient should be lying down. Alternate between the left and right anterolateral and posterolateral abdominal wall. Introduce the whole length of the needle into a skin fold held between the thumb and forefinger; hold the skin fold throughout the injection.

•       Apply pressure to all injection sites after needle is withdrawn; inspect injection sites for signs of hematoma; do not massage injection sites.

•       Do not mix with other injections or infusions.

•       Store at room temperature; fluid should be clear, colorless to pale yellow.

•       Provide for safety measures (electric razor, soft toothbrush) to prevent injury to patient who is at risk for bleeding.

•       Check patient for signs of bleeding; monitor blood tests.

•       Alert all health care providers that patient is on enoxaparin.

•       Discontinue and initiate appropriate therapy if thromboembolic episode occurs despite enoxaparin therapy.

•       Have protamine sulfate (enoxaparin antidote) on standby in case of overdose.

•       Treat overdose as follows: Protamine sulfate (1% solution). Each mg of protamine neutralizes 1 mg enoxaparin. Give very slowly IV over 10 min.

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