Dr. Saltiel received his Pharm.D. from the University of California, San Francisco, in 1980, following undergraduate work at UCLA. At UCSF, he was the recipient of the Outstanding Service Award and the Bowl of Hygeia Award. He completed a residency in clinical pharmacy practice at the University of Illinois, in Chicago.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Enoxaparin is a low molecular weight heparin. Like heparin, enoxaparin prevents blood clots from forming. It works by blocking the action of two of the 12 proteins in blood (factors X and II) whose action is necessary in order for blood to clot. The FDA approved enoxaparin in 1993.
PRESCRIPTION: Yes
GENERIC AVAILABLE: No
PREPARATIONS: Enoxaparin is available in pre-filled syringes containing 30, 40, 60, 80, 100, 120, and 150 mg.
STORAGE: All enoxaparin products should be stored at room temperature, between 15 and 30°C (59-86°F).
PRESCRIBED FOR: Enoxaparin is used to treat or prevent blood clots and their complications (deep vein thrombosis and pulmonary embolism). Deep-vein thrombosis is the formation of blood clots in veins deep in a muscle, most often in the legs. Deep vein thrombosis may lead to pulmonary embolism, a condition in which a piece of the clot (the embolus) breaks loose and travels through the veins to the lung. In the lung the clot blocks an artery and prevents the part of the lung that is supplied by the artery from working normally. If the artery that is blocked is a large artery, the embolus can cause sudden death. Thrombosis and embolism are responsible for 300,000 to 600,000 hospitalizations each year, and pulmonary embolism causes as many as 200,000 deaths each year in the U.S. Patients undergoing hip replacement and other major surgery are at increased risk of deep-vein thrombosis and pulmonary embolism.
DOSING: For the prevention of
blood clots, the usual dose of enoxaparin is 30 mg twice daily or 40 mg once daily by subcutaneous (under the skin) injection. For the treatment of an existing blood clot, the usual dose is based on the weight of the patient-1 mg per kg (about 0.5 mg per pound) twice daily or 1.5 mg per kg (about 0.8 mg per pound) once daily. The dose is dependent on the specific reason for which enoxaparin is being used. For example, in the hospital, enoxaparin is routinely used at a dose of 30 mg twice daily for seven to 10 days after hip-replacement surgery or knee-replacement surgery. It may be continued at home for up to three weeks following hip-replacement surgery with once-a-day (40 mg) dosing. The dose of enoxaparin is reduced for patients with severe impairment of kidney function.
Enoxaparin is given only by subcutaneous injection. It must not be administered by intramuscular injection. Patients may inject themselves if their physician determines that it is appropriate and with medical follow-up, as necessary. Proper training in subcutaneous injection technique should be provided.
To self-administer enoxaparin, patients should be lying down. Administration should be alternated between the left and right front abdominal wall, towards the sides. The whole length of the needle should be inserted into a fold of skin held between the thumb and forefinger; the skin fold should be held throughout the injection. To minimize bruising, the site of the injection should not be rubbed after completion of the injection. The syringe should be discarded immediately in a special container for sharp objects after the injection.
DRUG INTERACTIONS: Medications that increase the risk of bleeding will add to the effects of enoxaparin and further increase the risk of bleeding that is associated with enoxaparin. Such medications include aspirin, clopidogrel (Plavix), and the nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin; Advil), naproxen (Naprosyn), diclofenac (Voltaren), and others.
PREGNANCY: Enoxaparin does not cross the placenta and shows no evidence of effects on the fetus. It often is used during pregnancy as an alternative to oral anticoagulants such as warfarin (Coumadin), which cannot be safely used during
pregnancy.
NURSING MOTHERS: It is not known if enoxaparin is excreted in
breast milk. Since most medicines are excreted in breast milk, it is recommended that women receiving enoxaparin should not breast feed.
SIDE EFFECTS: The most common side effect associated with enoxaparin is bleeding. Less commonly, enoxaparin can induce an increase in liver tests in the blood, suggesting mild damage to the liver, and a reduction in blood platelets. Mild local irritation, pain, hematoma, ecchymosis, and erythema may occur at the site of injection.
Deep vein thrombosis (DVT) is a blood clot in a vein located deep in the muscles of the legs, thighs, pelvis (lower torso), or arms. The most common symptoms of a deep vein thrombosis are swelling and pain in the leg that has the blood clot. A DVT is difficult to diagnose without specific tests in which the deep vein system can be examined.
Thrombocytopenia refers to a decreased number of platelets in the blood. There are many causes of thrombocytopenia such as decreased platelet production (viral infections for example rubella, mumps, chickenpox, hepatitis C, and HIV); increased platelet destruction or consumption (for example sulfonamide antibiotics, heparin, blood transfusions, and lupus); or increased splenic sequestration (enlarged spleen due to conditions for example liver disease, blood cancers, and more). Treatment of thrombocytopenia depends on the cause.
Phlebitis is the inflammation of a vein. Thrombophlebitis is when a blood clot causes the inflammation. Phlebitis can be superficial or deeper in the veins. A blood clot deep in a vein is deep vein thrombosis (DVT). Some of the common causes of phlebitis include prolonged inactivity, varicose veins, trauma to a vein, underlying cancers, clotting disorders, etc. Symptoms of phlebitis may be mild (pain, tenderness, redness, or bulging of a vein. Treatment of phlebitis depends on the cause.
Arteries have thin muscles within their walls to be able to withstand
the pressure of the heart pumping blood to the far reaches of the body.
Veins don't have a significant muscle lining, and there is nothing pumping blood
back to the heart except physiology. Blood returns to the heart because
the body's large muscles squeeze the veins as they contract in their
normal activity of moving the body. The normal activities of moving the
body returns the blood back to the heart.
There are two types of veins in the leg; superficial veins and deep veins. Superficial veins lie just below the skin and are easily seen on the surface.
Deep veins, as their name implies, are located deep within the muscles of
the leg. Blood flows from the superficial veins into the deep venous system through
small perforator veins. Superficial and perforator veins have one-way valves
within them that allow blood to flow only in the direc...