Continuum of care

Nursing care from admission through hospitalization and follow-up

While nurses and case managers may not be responsible for all the steps required to transition care safely, it is important that they participate in the overall plan to make sure that transitions occur smoothly.³⁶

Questions that may need to be asked include:³⁶

What is the proper setting for this individual to receive care?
What medications will the patient be sent home on?
Is the patient continuing the prophylaxis treatment after discharge?
Does the case manager know exactly what medications and doses the patient should be taking at the time of discharge?
If the patient is not going home, what arrangements must be made for follow-up blood and lab work?
Is the patient going home with visiting nurse services?

National Patient Safety Goal 8: accurately and completely reconcile medications across the continuum of care²

For the latest updates on quality measures and guidelines that affect thrombosis management there is a single source.

Continuing Steps supports your hospital as you strive for quality and performance improvement. Registering for this comprehensive hospital initiative will provide you with information and practical tools to help you meet current guidelines and help lower patient risk for thrombotic events.

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 nonsteroidal 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 (UFH), 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 (HCT) or blood pressure should lead to a search for a bleeding site. (See WARNINGS and PRECAUTIONS.)

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

Thrombocytopenia can occur with LOVENOX®. In patients with a history of heparin-induced thrombocytopenia (HIT), 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 HIT have been observed in clinical practice. (See WARNINGS and PRECAUTIONS.)

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

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

For more information, contact your local sanofi-aventis U.S. Representative or call sanofi-aventis U.S. Medical Information Services at 1-800-633-1610.

Please see full Prescribing Information including boxed WARNING.

Prescription LOVENOX® is available in pharmacies.

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