Enoxaparin

DEA Class; Rx

Common Brand Names; Lovenox

• Anticoagulants, Cardiovascular; 
• Anticoagulants, Hematologic

Active major bleeding, thrombocytopenia with antiplatelet antibody in presence of enoxaparin or heparin

History of heparin-induced thrombocytopenia (HIT) within past 100 days or in presence of circulating antibodies

Hypersensitivity to enoxaparin, heparin, pork products, benzyl alcohol (multiple dose formulations only) or other ingredients

Epidural or spinal hemorrhage and subsequent hematomas reported with the use of enoxaparin and epidural or spinal anesthesia/analgesia or spinal puncture procedures, resulting in long-term or permanent paralysis (see Black Box Warnings)

Use with caution in patients with a bleeding diathesis, uncontrolled arterial hypertension or a history of recent gastrointestinal ulceration, diabetic retinopathy, renal dysfunction and hemorrhage

Bleeding may occur; monitor patients with risk factors including congenital or acquired bleeding disorders, bacterial endocarditis, severe uncontrolled hypertension, hemorrhagic stroke, used shortly after brain, spinal, or ophthalmic surgery in patients treated concomitantly with platelet inhibitors or history of heparin induced thrombocytopenia, severe liver disease, diabetic retinopathy, patients undergoing invasive procedures, active ulcerative or angiodysplastic diseases, recent GI bleeding or ulceration

To minimize risk of bleeding following PCI, achieve hemostasis, at puncture site after PCI; sheath can be removed immediately if closure device used; if manual compression used remove sheath 6 hr after last IV/SC dose of enoxaparin; additional doses not recommended until 6-8 hr after sheath removal; observe for signs of bleeding/hematoma formation

Multidose formulation contains benzyl alcohol preservative, linked to fatal “gasping syndrome” in premature neonates

Monitor for hyperkalemia (possibly from aldosterone suppression); mainly a concern among patients with risk factors including renal dysfunction, concomitant use of potassium sparing diuretics or potassium supplements

Human data from a retrospective cohort study, suggest that enoxaparin does not increase risk of major developmental abnormalities

Lactation: Excretion in milk unknown; not recommended