Name: Enoxaparin (Lovenox)
Class: Antithrombotic Agent (Anticoagulant) (Low Molecular Weight Heparin)
Mechanism: Catalyzes complex formation btwn. plasma antithrombin III and various serine proteases of the coagulation pathway, including thrombin and activated factors IX, X, XI, & XII. Effect primarily due to thrombin inhib. Less effect on thrombin than heparin. Prevents further clot formation and thrombus propagation. Does not alter organized clots.
Absorp.: SC ® better bioavail. than heparin. Daily SC injxn has sim. efficacy to 2-3 injxns/d of heparin.
Dist.: Metabolism.: Hepatic.
Excretion, t½: Longer t½ than heparin. ¯ t½ w/pulm. embolism. t½ w/hepatic cirrhosis or end-stage renal disease.
Toxicity/S.E.s: 1° = bleeding. Thrombocytopenia (bovine > porcine)—mild, severe (delayed onset; can occur w/heparin resistance ® thromboembolism & DIC). Long-term use ® osteoporosis. Non-teratogenic, but discontinue prior to delivery.
Utility: 1° prevention of DVT after hip replacement surgery.
Special Features: Primarily used for venous thromboses. Monitor PTT to achieve desired dose—1.5-2.5x normal PTT is therapeutic. recurrence rate if PTT < style=""> Few drug interactions. Lower rate of bleeding than w/heparin.