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Medications – Antithrombotic Therapy: Lovenox Administration
Strength of Evidence Level: 3
PURPOSE:
To safely administer antithrombotic therapy.
CONSIDERATIONS:
1. Lovenox (enoxaparin) is a low-molecular weight
heparin. It is indicated for:
a. Prophylaxis of Deep Vein Thrombosis (DVT.)
b. Treatment of acute DVT.
c. Complications of unstable angina.
d. Treatment of acute ST-segment elevation
myocardial infarction.
2. Under normal circumstances, there is no need for
daily monitoring of the effect of Lovenox in patients
with normal baseline or presurgical coagulation
parameters.
3. Standard monitoring includes: periodic CBC’s,
including platelet count and stool occult blood tests.
4. Contraindications include patients with:
a. Active major bleeding.
b. Thrombocytopenia associated with a positive
test for anti-platelet antibody.
c. Hypersensitivity to enoxaparin sodium.
d. Hypersensitivity to heparin or pork products.
5. Caution should be used with patients:
a. Receiving other agents that affect homeostasis
such as non-steroidal anti-inflammatory drugs
(i.e. Toradol).
b. Oral anticoagulants and/or platelet inhibitors
(i.e. ASA).
6. Side effects following subcutaneous injection:
a. Local irritation.
b. Pain.
c. Hematoma and erythema.
d. Moderate thrombocytopenia.
e. Fever.
f. Nausea.
g. Hemorrhage.
h. Hypochromic anemia.
i. Edema.
j. Peripheral edema.
7. Lovenox cannot be used interchangeably (unit for
unit) with other low- molecular weight heparins or
infractioned (regular) heparins.
8. Lovenox is to be given subcutaneously only. DO
NOT administer via IV or IM injection.
EQUIPMENT:
Alcohol prep pad
Lovenox prefilled syringe (30 mg per 0.3 mL)
Protamine Sulfate (antidote-give same dose as
Lovenox), if ordered by physician
PROCEDURE:
1. Adhere to Standard Precautions.
2. Identify patient and explain procedure.
3. Lovenox is administered subcutaneously and only in
the abdomen, alternating doses between the left
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SECTION: 16.04
__RN__LPN/LVN__HHA
and right anterolateral and posterolateral wall. DO
NOT expel the air bubble when preparing Lovenox
or medication may be lost.
Follow the medication administration guidelines for
Subcutaneous Injection. (See MedicationsSubcutaneous Injection).
Instruct patient to inform staff of any new back pain,
abdominal pain, stiffness of the joints, coughing up
of brown/red mucous, nose bleeds and headaches,
and to watch for any signs of bleeding or bruising.
Instruct patient to avoid any over-the-counter
medications containing aspirin or other salicytes.
Apply pressure to any observed bleeding sites and
notify staff immediately.
Instruct patient and/or caregiver regarding
administration techniques.
AFTER CARE:
1. Document in patient’s record:
a. Medication administered, dose, time and route.
b. Patient’s response to procedure.
c. Instructions given to patient/caregiver.
d. Communication with physician, as needed.