A year old Caucasian man with a past medical history significant for bipolar disorder, schizophrenia, hypertension, and pulmonary embolism secondary to a hypercoagulable state caused by tetrahydrofolate reductase deficiency was found unresponsive and transported to the emergency department.
He was somnolent but arousable with bruising noted around multiple injection sites on his abdomen. The remainder of his physical exam was unremarkable, and he exhibited no overt signs of bleeding. Anti- factor Xa levels were not available at the time of treatment. An initial dose of protamine sulfate, mg mixed in ml of 0. Repeat aPTT was 61 seconds. A second infusion of protamine sulfate was administered 2 hours later, and the aPTT decreased further to 49 seconds.
Rebound phenomenon was noted 3—8. At 24 hours, the aPTT was 46 seconds. The patient did not exhibit any signs of bleeding during treatment, and tolerated the infusions of protamine sulfate without any adverse effects. Subsequent testing for anti-factor Xa revealed an initial level of 4.
The anti-factor Xa level at 24 hours was 1. The reversal of an enoxaparin overdose is challenging and frequently difficult to manage. Reversal with protamine sulfate is often incomplete, and infusion of the recommended dosage of 1 mg for each 1 mg of enoxaparin can be risky in large dosages. Lovenox is indicated for the prophylaxis of deep vein thrombosis, which may lead to pulmonary embolism: In patients undergoing abdominal surgery who are at risk for thromboembolic complications.
In patients undergoing hip-replacement surgery, during and following hospitalization. When should you not give Lovenox? You should not use Lovenox if you are allergic to enoxaparin, heparin, benzyl alcohol, or pork products, or if you have: active or uncontrolled bleeding; or.
What time should Lovenox be given? When administered in conjunction with a thrombolytic fibrin specific or non—fibrin specific , administer Lovenox between 15 minutes before and 30 minutes after the start of fibrinolytic therapy. The usual duration of Lovenox therapy is 8 days or until hospital discharge. Can you fly while on Lovenox? Can I travel while taking enoxaparin? Yes, you can travel.
If on a long car or plane trip, try to move around every 2 to 3 hours to decrease the risk of getting blood clots. Does Lovenox lower your blood pressure? Enoxaparin is a type of low molecular weight heparin and belongs to the group of medications known as anticoagulants or antithrombotic agents. These medications reduce the clotting ability of the blood and can reduce the risk of harmful blood clots forming in blood vessels. What are scalars and vectors?
How long do you wear an external fixator? As with most medications, it is possible to take too much Lovenox. As you might predict, an overdose with this medication increases the risk of dangerous bleeding. Symptoms of an Overdose In cases of mild overdose, it is possible that no symptoms may occur. Bleeding including dangerous internal bleeding is most likely to occur with large overdoses.
Symptoms that may occur include but are not limited to:. Treatment for a Lovenox Overdose The anticoagulant effects of Lovenox can be largely but not entirely reversed by a medication known as protamine sulfate. Treatment may not be necessary or advisable if the overdose occurred 12 hours or more previously. Treatment with protamine must be undertaken with great care, as the drug may sometimes cause dangerously low blood pressure hypotension or life-threatening allergic reactions.
Of course, treatment for a Lovenox overdose will also consist of treating any of the symptoms and problems that arise as the result of the overdose. This type of treatment must be individualized for each patient, according to the particular situation.
It is important that you seek prompt medical attention if you believe you may have overdosed on this medication. Are There Foods for Type 2 Diabetes? List of references click here Lovenox [package insert]. Lovenox falls into category B. Studies in animals have failed to demonstrate a risk to the unborn baby, and there are no well-controlled studies in pregnant women.
You should not take Lovenox if you are breastfeeding. It is not known if Lovenox is excreted in human breast milk or if it will harm your nursing baby. You may receive Lovenox while you are still in the hospital. Your healthcare provider will probably be giving you the injections. In some cases you will receive injections directly into a vein IV. Before you leave the hospital, your healthcare provider will teach you to give yourself the injections, or he or she may teach someone else to give you the injections.
When you are injecting the medication at home, you will be injecting it just under the skin subcutaneously. Lovenox should not be injected into muscle. Make sure the drug is clear and colorless or pale yellow. Each syringe has one dose of Lovenox. Take the cap off the needle. Do not push any air or drug out of the syringe before giving the shot unless your healthcare provider tells you to. While lying down, pinch a fold of skin between your finger and thumb. Inject the medication after pushing the entire needle into the skin and pressing down on the syringe plunger.
Release the skin after Lovenox is injected. Do not rub the area of the injection. If you miss a dose, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses of Lovenox at the same time.
Take Lovenox exactly as prescribed by your doctor. Follow the directions on your prescription label carefully. If you take too much Lovenox or you suspect you are given too much, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.
Epidural or spinal hematomas may occur in patients who are anticoagulated with low molecular weight heparins LMWH or heparinoids and are receiving neuraxial anesthesia or undergoing spinal puncture. These hematomas may result in long-term or permanent paralysis. Consider these risks when scheduling patients for spinal procedures.
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