Master Enoxaparin (Lovenox) with Picmonic for Physician Assistant

Unlike standard heparin which inactivates factors IIa (thrombin) and Xa, enoxaparin primarily inactivates factor Xa, and inactivates IIa to a lesser amount. This prevents clots from forming, making it a safe and effective way of preventing clot formation.

Enoxaparin works by binding to antithrombin, forming a complex which irreversibly inactivates clotting factor Xa.

Enoxaparin can be used in the prevention of DVTs after surgeries, treatment of established DVTs, and patients with unstable angina or an acute STEMI.

HIT is an immune reaction to the heparin molecule that causes an activation of platelet formation. This syndrome presents with both platelet consumption and platelet activation simultaneously. This can be seen with platelet levels dropping most often within 5-10 days, and the patient may exhibit signs of DVTs. Signs of thrombocytopenia include low platelet levels, spontaneous bleeding, easy bruising and petechiae.

Monitor for signs/symptoms of bleeding, such as occult blood, bleeding around the gums, petechiae (especially in the lower extremities), and ecchymosis (bruised areas under the skin from blood escaping capillaries). Patients can be easily bruised and bleed longer than usual from blood draws or cuts so educate on the importance of avoiding minor tissue injuries to prevent ecchymosis.

Before administering a new mediation, educate the patient on the indication and side effects. If the patient is going home on enoxaparin, have them demonstrate proper administration technique. Patients taking anticoagulants should be educated to use electric razors and soft bristled toothbrushes, avoid scenarios which may arise in injury, and to never stop taking anticoagulants abruptly.

Enoxaparin is administered subcutaneously. SubQ injections are given at a 45-90 degree angle and do not require aspiration. Be sure to rotate injection sites and hold direct pressure to the area following administration of enoxaparin for up to 10 minutes until the site is no longer bleeding.

Always administer the medication 2 inches away from the umbilicus or any abdominal incision. Areas around these sites have more scar tissue in the area and do not allow for the absorption of the medication to happen regularly.

Protamine sulfate is the antidote and a dose of 1 mg for each milligram of enoxaparin that was administered is given. Protamine sulfate binds directly to the free heparin in the bloodstream and inactivates it, immediately preventing further inactivation of clotting factors.