7/24/2023 0 Comments Antidote for lovenox![]() ![]() Our case demonstrates the importance of monitoring renal function and the potential for accumulation of enoxaparin in patients with renal dysfunction leading to prolonged therapeutic anti-Xa assays. Along with resuscitative efforts, an interdisciplinary team collaborated to administer protamine sulfate 50 mg intravenous once (0.5 mg per 1 mg of enoxaparin) to reverse the therapeutic anticoagulation. We present a case of a hemodynamically unstable patient with an enoxaparin induced abdominal wall hematoma/hemorrhage and the previous enoxaparin administration 21.5 h prior to presentation with a therapeutic anti-Xa assay (0.8 IU/mL) upon assessment in the emergency department. Upper Saddle River, NJ: Pearson Prentice Hall.Clinical practice guidelines recommend protamine sulfate for reversal of enoxaparin associated bleeds dependent on the time from last administration and dose of enoxaparin. Prentice Hall Nurse's Drug Guide 2007 (pp. Wilson, B.A., Shannon, M.T., Shields, K.M., & Stang, C.L. ![]() Lough's (Eds.) Critical care nursing: Diagnosis and management (6th ed., p. Pharmacology for nursing care (7th ed., pp. In Davis' drug guide for nurses (11th ed., pp. Salem, MA: AHA.ĭeglin, J.H., & Vallerand, A.H. Low molecular weight heparin (e.g., enoxaparin) is preferred for unstable angina and NSTEMI over unfractionated heparin.Īmerican Heart Association. Monitor injection sites for signs of hematoma.Īpply direct pressure to venipuncture sites for longer durations (e.g., 3 minutes). Monitor periodically CBC for blood counts.Īssess urine and stool for signs of blood. Only routes of administration are IV or SQ (does not absorb PO IM causes hematoma) Protamine sulfate is the antidote for enoxaparin. Drug Incompatibilities: Primarily given SQ.Drug Interactions: 1) Aspirin, NSAIDS, oral anticoagulants, and anti-platelet drugs may increase the risk of bleeding 2) feverfew, ginkgo, ginger, garlic, and horse chestnut may increase the risk of bleeding 3) Protamine sulfate is an antagonist to enoxaparin (1 mg protamine for every mg of enoxaparin).Subcutaneous: (for DVT and other uses) 30 mg SQ BID (pulmonary embolism) 1 mg/kg SQ BID.Intravenous: (for ACS only) 30 mg IV bolus followed by 1 mg/kg SQ BID for up to 8 days.Safety in pregnancy (category B) or children not established Use with caution in patients who are having lumbar puncture or regional anesthesia Recent intracranial, intraspinal, or eye surgery Thrombocytopenia (platelet count < 100,000) including idiopathic thrombocytopenic purpura (ITP)Īctive bleeding disorders (GI bleeding, peptic ulcer) Neurological injury for persons undergoing spinal canal procedures (spinal puncture, epidural anesthesia) Hypersensitivity (rash, urticaria), fever, arthralgia, angioedema ![]() Treatment of DVT with or without pulmonary embolism Prevention of DVT following surgery or during prolonged bedrest Inactivate clotting factor Xa, blocking the conversion of prothrombin to thrombin
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