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Enoxaparin (Lovenox)

Low molecular weight heparin (LMWH) anticoagulant

Mechanism of action

Binds antithrombin III to selectively inactivate factor Xa (with much less anti-IIa activity than unfractionated heparin). Predictable pharmacokinetics, no routine aPTT monitoring, weight-based subcutaneous dosing. Used for VTE prophylaxis and treatment, ACS, and bridging anticoagulation.

Adverse effects

Life-threatening / NCLEX-tested

  • Major bleeding — GI, intracranial, retroperitoneal
  • Spinal/epidural hematoma if given near neuraxial procedure (boxed warning)
  • Heparin-induced thrombocytopenia (HIT) — less common than with UFH but possible
  • Hyperkalemia (aldosterone suppression)
  • Anaphylaxis (rare)

Side effects

Common — what to teach

  • Injection-site bruising or hematoma
  • Mild thrombocytopenia
  • Elevated liver enzymes
  • Local irritation

Food & drug interactions

Bleeding risk multiplies with NSAIDs, aspirin, clopidogrel, warfarin, DOACs, and SSRIs. Avoid IM injections while anticoagulated. Renal dose adjustment is required when CrCl < 30 mL/min — dose reduces, and accumulation can be dangerous in kidney disease.

Nursing implications

Assessment, monitoring, patient teaching

  • Inject deep subQ in the abdominal "love handle" area, 2 inches from the umbilicus, with the air bubble in the prefilled syringe (do not expel)
  • Do not aspirate, do not rub the site after injection — rotate sites
  • Routine aPTT is NOT used; in select cases (renal impairment, pregnancy, extremes of weight) monitor anti-Xa level
  • Antidote is protamine sulfate — only partially reverses LMWH (~60%), so prevention matters more than reversal
  • Hold or adjust dose before invasive procedures and around neuraxial anesthesia per protocol
  • Monitor for bleeding signs: hematuria, melena, severe headache, oozing IV sites
  • Adjust dose for CrCl < 30 mL/min

When to hold / contraindications

  • Active major bleeding
  • Platelet count < 100,000/mm³ or > 50% drop from baseline (suspect HIT)
  • CrCl < 15 mL/min (often switch to UFH instead)
  • Recent or planned neuraxial anesthesia/lumbar puncture
  • Severe uncontrolled hypertension

Memory anchor

Lovenox = "Love handles, leave the bubble." SubQ in the abdomen, do not expel the air bubble, do not aspirate, do not rub. Antidote: protamine (partial).

Reminder: Drug cards are study aids, not clinical guidance. Always cross-check doses, holds, and contraindications with your facility's formulary and your clinical instructors before patient care.

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