Lovenox

Question 1

Treatment dose of lovenox

Prophylaxis dose of Lovenox

Answer 1

Treatment:
- 1mg/kg SC Q12H or 1.5mg/kg SVC QD

Prophylaxis:
- 40mg QD or 30mg BID

Question 2

Indication & Dosages:

• DVT ppx, hip/knee replacement
• DVT ppx abdomen surgery
• DVT/PE treatment
• MI/unstable angina/thrombolytic adjunct/PIC

Answer 2

DVT ppx, hip/knee replacement

• 30 mg SC Q12H start 12-24H post op x 7-10d
• Renal imp: CrCl < 30mL/min: 30 mg SC QD

DVT ppx abdomen surgery
- 40 mg SC QD start 2H pre-op no more than 12 days

DVT/PE treatment

• 1mg/kg SC Q12H until warfarin overlap
• Renal imp: CrCl < 30: 1mg/kg SC QD

MI/unstable angina/thrombolytic adjunct/PIC

• 1mg/kg SC Q12H w/ ASA
• > 75 y.o: 0.75mg/kg SC Q12H

Question 3

Lovenox dosage forms

Answer 3

• 30 mg prefilled syringes
• 40, 60, 80, 100, 120, 150 mg
• Multi-dose vial 300mg/3mL

Question 4

Renal dose adjustment

Answer 4

Yes, in CrCl < 30 mL/min

Question 5

ADEs

Answer 5

• Hypersensitivity: enoxaparin, dalteparin, tinzaparin: pork allergy
• Hemorrhage, thrombocytopenia, bruising
• Fever, confusion, rash

Question 6

Monitoring

Answer 6

• No routine monitoring like PT, PTT/INR needed
• Anti-Xa can be monitored
• Check CBC at baseline: platelet, Hgb, Hct

Question 7

Protamine

Answer 7

• DOC to reverse heparin and LMWH

- Binds to heparin & heparin like structure like + binds of - charge => can’t act as anticoag

Question 8

Dose of protamine for:

• Heparin:
• Dalteparin:
• Enoxaparin:

Answer 8

• Heparin: 1mg = 90U beef heparin & 115U of porcine heparin
  => 10-20 mg Protamine IV over at least 5min
• Dalteparin: 1mg protamine = 100U adm
• Enoxaparin: 1mg protamin = 1mg enoxaparin administered