Inpatient treatment of acute dvt with or without pe

This preview shows page 65 - 77 out of 114 pages.

inpatienttreatmentof acute DVT,with or without PE,when administered in conjunction with warfarinsodiumTheoutpatient treatmentof acute DVT,without PE, when administered in conjunctionwith warfarin sodium
Enoxaparin – Mechanism of actionInhibits factor Xa(preventing formation of XaVacomplex)Prevents conversion of prothrombin to thrombin by XaVacomplex
MetabolismEnoxaparin sodium is primarily metabolized in the liverRenal clearance of active fragments represents about 10% ofthe administered dose and total renal excretion of active andnon-active fragments 40% of the dose.Dose needs to be reduced or drug not used if the patient hasa decrease in creatinine clearance
Enoxaparin ContraindicationsActive major bleedingThrombocytopenia with a positive in vitro test for anti-plateletantibody in the presence of enoxaparin sodiumHypersensitivity to heparin or pork products
Warnings and PrecautionsIncreased risk of hemorrhageConcomitant medical conditionsbleeding diathesis, uncontrolled arterial hypertension or history ofrecent gastrointestinal ulceration, diabetic retinopathy, renaldysfunction, or hemorrhageHistory of HIT: Use with cautionThrombocytopeniaDo not exchange with heparin or other LMWHsPregnant women with mechanical prosthetic heart valves andtheir fetuses, may be at increased risk and may need morefrequent monitoring and dosage adjustment
Adverse ReactionsMost common adverse reactions (>1%) were bleeding,anemia, thrombocytopenia, elevation of serumaminotransferase, diarrhea, and nausea
Use in Specific PopulationsSevere Renal Impairment: Adjust dose for patientswith creatinine clearance <30mL/minGeriatric Patients: Monitor for increased risk ofbleedingPatients with mechanical heart valves: Notadequately studiedHepatic Impairment: Use with caution.Low-Weight Patients: Observe for signs ofbleeding
Safety WarningsEpidural or spinal hematomas may occur inpatients who are anticoagulated with lowmolecular weight heparins (LMWH) orheparinoids and are receiving neuraxialanesthesia or undergoing spinal puncture. Thesehematomas may result in long-term orpermanent paralysis. Consider these risks whenscheduling patients for spinal procedures.
Safety WarningsMonitor patients frequently for signs andsymptoms of neurological impairment. Ifneurological compromise is noted, urgenttreatment is necessary.Consider the benefits and risks before neuraxialintervention in patients anticoagulated or to beanticoagulated for thromboprophylaxisMay require IVC Filter
EnoxaparinProphylaxis:40 mg SC daily (adjust dose fordecrease in Cr clearance)Ortho prophylaxis:30 mg SC q12h, or 40mg oncedailyDVT with or without PE:1.5mg/kg/daily or1mg/kg q12h, with warfarinAcute DVT, outpatient, NO PE:1mg/kg daily, withwarfarinAcute DVT with severe renal impairment:1mg/kg daily
Patient MonitoringIf available use chromogenic anti-Xa heparinassay; aPTT is insensitiveCBCBMP
ReversalProtamine will reverse up to 60% of activeLMWH

Upload your study docs or become a

Course Hero member to access this document

Upload your study docs or become a

Course Hero member to access this document

End of preview. Want to read all 114 pages?

Upload your study docs or become a

Course Hero member to access this document

Term
Spring
Professor
NoProfessor
Tags
Low molecular weight heparin

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture