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Glossary

Glossary

ACC
American College of Cardiology

ACCP
American College of Chest Physicians

ACS
Acute Coronary Syndrome. This is a term used to cover the group of clinical symptoms compatible with acute myocardial ischemia. Acute myocardial ischemia is chest pain due to insufficient blood supply to the heart muscle that results from coronary artery disease (also called coronary heart disease).

ACUTE
Antithrombotic Combination Using Tirofiban and Enoxaparin II. A randomized double-blind safety study of enoxaparin vs. unfractionated heparin in patients with non-ST elevation acute coronary syndromes treated with tirofiban and aspirin

AHA
American Heart Association

aPTT
Activated Partial Thromboplastin Time: a commonly performed test for thromboplastin that detects abnormalities in blood clotting time and to monitor the efficacy of treatment with anticoagulant agents.

ASRA
American Society of Regional Anesthesia

A-to-Z
Aggrastat to Zocor: an ongoing international, multicenter, randomized study investigating combined use of low-molecular-weight heparin with the glycoprotein IIb/IIIa inhibitor tirofiban and defining the efficacy of early aggressive simvastatin therapy.

CABG
Coronary Artery Bypass Graft: An operation in which a section of vein or artery is used to bypass a blockage in a coronary artery; performed to relieve angina and reduce the risk of death from coronary artery disease.

Creatine
A compound formed by the metabolism of creatine, found in muscle tissue and blood and normally excreted in the urine as a metabolic waste. Measurement of creatinine levels in the blood is used to evaluate kidney function.

CRUSADE
Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse Outcomes with Early Implementation of the ACC/AHA Guidelines: a multidisciplinary cooperative effort involving over 400 emergency departments (EDs) and medical centers which includes an ACS registry designed to characterize demographic patterns and risk stratification results in patients who meet diagnostic criteria for high-risk non-ST elevation acute coronary syndromes, and measures the use of ED treatment modalities including aspirin, heparin, beta-blockers, and platelet inhibitors as recommended in the ACC/AHA guidelines

DVT
Deep Vein Thrombosis: a condition in which a blood clot (thrombus) develops in deep veins of the body, most often in the deep veins of the legs, either above the knee or below it

ENOXACAN
ENOXAparin and CANcer: a double-blind randomized multicenter trial with venographic assessment investigating efficacy and safety of enoxaparin versus unfractionated heparin for prevention of deep vein thrombosis in elective cancer surgery

ESSENCE
Canadian Efficacy and Safety of Subcutaneous ENoxaparin in Non-Q-Wave Coronary Events: A multicenter, double blind, placebo-controlled study investigating efficacy and safety of subcutaneous enoxaparin versus intravenous unfractionated heparin, in non-Q-wave coronary events

Frontline Registry
The Fundamental Research in Oncology and Thrombosis (FRONTLINE) study is the first comprehensive global survey of thrombosis and cancer, and was designed to collect data on the perceived risk and patterns of practice with regard to VTE in cancer patients undergoing surgical and medical management of their malignancy and to provide information on international and regional practice patterns, allowing for the design of research studies to answer the concerns of practicing clinicians.

GUSTO IIb
Global Use of Strategies To Open Occluded Coronary Arteries in Acute Coronary Syndromes IIb: A multicenter, randomized clinical trial investigating a comparison of recombinant hirudin with heparin for the treatment of acute coronary syndromes

HEMODIALYSIS
In medicine, hemodialysis is a method for removing waste products such as potassium and urea, as well as free water from the blood when the kidneys are incapable of this (ie, in renal failure). Hemodialysis is typically conducted in an undedicated facility, either a special room in a hospital or a clinic (with specialized nurses and technicians) that specializes in hemodialysis. Although less typical, dialysis can also be done in a patient's home as home hemodialysis.

HIT
Heparin-Induced Thrombocytopenia: thrombocytopenia (low platelet counts) potentially due to the administration of unfractionated heparin (UFH), also observed with low molecular weight heparin (LMWH), danaparoid and related medications

INR
International Normalized Ratio: a system established by the World Health Organization (WHO) and the International Committee on Thrombosis and Hemostasis for reporting the results of blood coagulation (clotting) tests. All results are standardized using the international sensitivity index for the particular thromboplastin reagent and instrument combination utilized to perform the test.

INTERACT
INTegrilin and Enoxaparin Randomized Assessment of Acute Coronary Syndrome Treatment: A randomized evaluation of the safety and efficacy of enoxaparin versus unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes receiving the glycoprotein IIb/IIIa inhibitor eptifibatide

LDUH
Low Dose Unfractionated Heparin

LMWH
Low-Molecular-Weight Heparin

MEDENOX
Prophylaxis in MEDical Patients with ENOXaparin: a multicenter, multinational, double-blind study to evaluate the efficacy and safety of thromboprophylaxis in acutely ill medical patients who may be at risk for DVT/PE.

MOA
Mechanism of Action: an identification of the specific molecular targets to which a pharmacologically active substance binds or whose biochemical action it influences

NSTEMI
Non-ST Segment Elevation Myocardial Infarction (NSTEMI): an acute process of myocardial ischemia with sufficient severity and duration to result in myocardial necrosis Part of Acute Coronary Syndrome (see ACS).

PE
Pulmonary Embolism occurs when blood clots, developed in the deep leg veins caused by deep vein thrombosis (DVT), break off from the vein walls and travel through the heart to the pulmonary arteries

SYNERGY
Superior Yield of the New Strategy of Enoxaparin, Revascularization, and Glycoprotein IIb/IIIa Inhibitors: a prospective, randomized, open-label, multicenter, international trial investigating comparison of treatment with either subcutaneous enoxaparin or unfractionated heparin on patients with NSTEMI.

THE-PRINCE
THromboEmbolism PRevention INCardiac or Respiratory Disease with Enoxaparin: A multicenter, controlled, randomized, open study to compare the efficacy and safety of the low-molecular weight heparin enoxaparin with unfractionated heparin (UFH) for the prevention of venous thromboembolic disease in patients with heart failure or severe respiratory disease.

TIMI
Thrombolysis In Myocardial Infarction

UA
Unstable Angina. Form of angina pectoris (chest pain) characterized by sudden changes in the severity or length of attacks (usually grouped with similar conditions as the acute coronary syndrome).

VTE
Venous ThromboEmbolism. Formation of a blood clot in the veins which can travel from the site where it formed and block blood flow at another location.

Prophylaxis
Prevention of or protective treatment for disease.


Important Safety Information

WARNING: SPINAL/EPIDURAL HEMATOMAS

When neuraxial anesthesia (epidural/spinal anesthesia) or spinal puncture is employed, patients anticoagulated or scheduled to be anticoagulated with low-molecular-weight heparins or heparinoids for prevention of thromboembolic complications are at risk of developing an epidural or spinal hematoma which can result in long-term or permanent paralysis.

The risk of these events is increased by the use of indwelling epidural catheters for administration of analgesia or by the concomitant use of drugs affecting hemostasis such as non steroidal anti-inflammatory drugs (NSAIDs), platelet inhibitors, or other anticoagulants. The risk also appears to be increased by traumatic or repeated epidural or spinal puncture.

Monitor patients for signs and symptoms of neurological impairment. If neurologic compromise is noted, urgent treatment is necessary.

Consider the potential benefit versus risk before neuraxial intervention in patients anticoagulated or to be anticoagulated for thromboprophylaxis. (See WARNINGS and PRECAUTIONS[5.1] and Drug Interactions[7]).

LOVENOX® (enoxaparin sodium injection) cannot be used interchangeably with other low-molecular-weight heparins or unfractionated heparin, as they differ in their manufacturing process, molecular weight distribution, anti-Xa and anti-IIa activities, units, and dosage.

As with other anticoagulants, use with extreme caution in patients with conditions that increase the risk of hemorrhage. Dosage adjustment is recommended in patients with severe renal impairment. Unless otherwise indicated, agents that may affect hemostasis should be discontinued prior to LOVENOX® therapy. Bleeding can occur at any site during LOVENOX® therapy. An unexplained fall in hematocrit or blood pressure should lead to a search for a bleeding site. (See WARNINGS and PRECAUTIONS.)

In the STEMI pivotal trial, the rates of major hemorrhages (defined as requiring 5 or more units of blood for transfusion, or 15% drop in hematocrit or clinically overt bleeding, including intracranial hemorrhage) at 30 days were 2.1% in the LOVENOX® group and 1.4% in the unfractionated heparin group. The rates of intracranial hemorrhage at 30 days were 0.8% in the LOVENOX® group and 0.7% in the unfractionated heparin group. The 30-day rate of the composite endpoint of death, myocardial infarction or ICH (a measure of net clinical benefit) was significantly lower in the LOVENOX® group (10.1%) as compared to the unfractionated heparin group (12.2%).

Thrombocytopenia can occur with LOVENOX®. In patients with a history of heparin-induced thrombocytopenia, LOVENOX® should be used with extreme caution. Thrombocytopenia of any degree should be monitored closely. If the platelet count falls below 100,000/mm3, LOVENOX® should be discontinued. Cases of heparin-induced thrombocytopenia have been observed in clinical practice. (See WARNINGS.)

The use of LOVENOX® has not been adequately studied for thromboprophylaxis in pregnant women with mechanical prosthetic heart valves. (See WARNINGS.)

LOVENOX® is contraindicated in patients with hypersensitivity to enoxaparin sodium, heparin, or pork products, and in patients with active major bleeding.

Please see full Prescribing Information including boxed WARNING.

Last Update: July 2007

Prescription LOVENOX® is available in pharmacies.

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