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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 4. 5. 6. 7. 8. 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.