Medical patients during acute illness | |
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Dosing | 40 mg subcutaneous once daily |
Duration
of therapy |
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Dosing Calculator
Determine a patient's suggested dosage by entering the appropriate information when the tool prompts you. Select if severe renal impairment is a consideration. You may also need to know the patient's weight.
Calculated Dose
based on 100 mg/mL concentration
*subcutaneously
Dosage Forms and Strengths1
Lovenox has once-daily dosing for medical patients at risk for thromboembolic complications due to severely restricted mobility during acute illness, including fixed dosing across durations of therapy.
Lovenox has proven outcomes in once-daily dosing of medically ill patients, offering:
Medical patients during acute illness | |
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Dosing | 40 mg subcutaneous once daily |
Duration
of therapy |
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Many hospitalized acutely ill medical patients and surgical patients may develop deep vein thrombosis/pulmonary embolism (DVT/PE) as outpatients.
Appropriate length of DVT prophylaxis begins in the hospital and may continue with outpatient therapy.
Acute medical illness | |
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Average hospital LOS | 5 days |
Usual duration of
administration with Lovenox |
6 to 11 days |
See the dosing and duration of therapy information for patient types across prophylaxis of DVT patients.
Hip replacement surgery, during and following hospitalization | |
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Dosing |
30 mg subcutaneously every 12 hours (initiated 12 to 24 hours postoperatively)
provided hemostasis has been established at the wound site or
40 mg subcutaneously once daily may be considered (initiated 12 ± 3 hours preoperatively) |
Duration
of therapy |
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Continued prophylaxis in hip replacement surgery | |
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Dosing | 40 mg subcutaneously once daily (following initial phase of thromboprophylaxis) 40 mg SC once daily may be considered |
Duration
of therapy |
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Knee replacement surgery | |
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Dosing |
30 mg subcutaneously every 12 hours
(initiated 12 to 24 hours postoperatively) provided hemostasis has been established at the wound site |
Duration
of therapy |
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Severe renal impairment
(CrCl <30mL/min) |
|
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Dosing | 30 mg subcutaneously once daily |
Duration
of therapy |
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CrCI=creatinine clearance
Abdominal surgery | |
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Dosing |
40 mg subcutaneously once daily
(initiated 2 hours prior to surgery) |
Duration
of therapy |
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Severe renal impairment
(CrCl <30>) |
|
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Dosing | 30mg subcutaneously once daily |
Duration
of therapy |
|
Lovenox requires no dose adjustments with moderate (CrCl=30 to 50 mL/min) and mild (CrCl=30 to 50 mL/min) renal impairment; all such patients should be observed carefully for signs and symptoms of bleeding.
Lovenox may be largely neutralized (up to 60%) by slow intravenous injection of protamine sulphate (1% solution).
See the dosing and duration therapy information in the inpatient or outpatient settings for treatment of acute DVT.
Inpatients with acute DVT, with or without PE | |
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Dosing |
1.5 mg/kg subcutaneously once daily
(at the same time every day) or 1 mg/kg subcutaneously every 12 hours (both in conjunction with warfarin sodium therapy) |
Duration
of therapy |
7 days; minimum of
5 days, until INR=2.0-3.0; administered up to 17 days in controlled clinical trials |
Outpatients with acute DVT, without PE | |
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Dosing |
1 mg/kg subcutaneously every 12 hours
(in conjunction with warfarin sodium therapy) |
Duration
of therapy |
7 days; minimum of
5 days, until INR=2.0-3.0; administered up to 17 days in controlled clinical trials |
Inpatients (with acute DVT, with or without PE) or outpatients (with acute DVT, without PE) with severe renal impairment (CrCl <30mL/min) | |
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Dosing |
1 mg/kg subcutaneously once daily
(in conjunction with warfarin sodium therapy) |
Duration
of therapy |
7 days; minimum of
5 days, until INR=2.0-3.0; |
See the dosing and duration of therapy information for prophylaxis of ischemic complications in UA/NSTEMI patients.
UA/NSTEMI
(non-Q-wave MI) |
|
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Dosing |
1 mg/kg subcutaneously every 12 hours
(in conjunction with oral aspirin therapy 100 mg to 325 mg once daily) |
Duration of therapy |
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Severe renal impairment
(CrCI <30mL/min) |
|
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Dosing |
1 mg/kg subcutaneously once daily
(in conjunction with oral aspirin therapy 100 mg to 325 mg once daily) |
Duration of therapy |
|
UA/NSTEMI=unstable angina/non-ST-segment elevation MI.
Lovenox requires no dose adjustments with moderate (CrCI=30 to 50 mL/min) and mild (CrCI=50 to 80 mL/min) renal impairment; all such patients should be observed carefully for signs and symptoms of bleeding.
Lovenox may be largely neutralized (up to 60%) by slow intravenous injection of protamine sulphate (1% solution).
See the dosing and duration of therapy information for the treatment of acute STEMI patients.
<75 years of age | |
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Dosing | 30 mg single intravenous bolus plus 1 mg/kg subcutaneously followed by 1 mg/kg subcutaneously every 12 hours (maximum 100 mg for each of these 2 subcutaneous doses only, followed by 1 mg/kg dosing for the remaining doses). In pivotal trial, first subcutaneous dose given within 15 minutes of intravenous bolus 1 |
Duration of therapy | Lovenox treatment duration in the pivotal clinical trial was 8 days or until hospital discharge, whichever came first. An optimal duration of treatment is not known, but it is likely to be longer than 8 days |
<75 years of age
renal impairment (CrCl <30>ml/min) |
|
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Dosing | 30 mg single intravenous bolus plus 1 mg/kg subcutaneously followed by 1 mg/kg subcutaneously once daily |
Duration of therapy | Lovenox treatment duration in the pivotal clinical trial was 8 days or until hospital discharge, whichever came first |
≥75 years of age | |
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Dosing | No initial intravenous bolus; 0.75 mg/kg subcutaneously every 12 hours (maximum 75 mg for each of the first 2 subcutaneous doses only, followed by 0.75 mg/kg dosing for the remaining doses) |
Duration of therapy | Lovenox treatment duration in the pivotal clinical trial was 8 days or until hospital discharge, whichever came first. An optimal duration of treatment is not known, but it is likely to be longer than 8 days |
≥75 years of age with severe
renal impairment (CrCl <30>) |
|
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Dosing | No initial intravenous bolus; 1 mg/kg subcutaneously once daily |
Duration of therapy | Lovenox treatment duration in the pivotal clinical trial was 8 days or until hospital discharge, whichever came first |
CrCI=creatinine clearance
All patients should receive ASA as soon as they are identified as having STEMI, and maintained with 75 mg to 325 mg once daily, unless contraindicated.
The only adverse reaction that occurred at a rate of at least 0.5% in the Lovenox group was thrombocytopenia (1.5%).
See information about the use of Lovenox across different special population types.
Pregnancy |
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Nursing mothers |
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Pediatric use |
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Geriatric use—DVT in hip or knee replacement and abdominal surgery; treatment of DVT; prevention of ischemic complications of UA and non-Q-wave MI |
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Geriatric use—treatment of acute STEMI |
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Patients with mechanical prosthetic heart valves |
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Renal Impairment |
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Hepatic impairment |
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Low-weight patients |
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Obese patients |
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DVT=deep vein thrombosis; Ml=myocardial infarction; STEMI=ST-segment elevation myocardial infraction; UA=unstable angina.
Lovenox may be largely neutralized (up to 60%) by slow intravenous injection of protarnine sulfate (1% solution).
See the dosage specifications for specific indications and patient types.
Because exposure of Lovenox is significantly increased in patients with severe renal impairment (creatinine clearance <30 mL/min), a dosage adjustment is recommended for therapeutic and prophylactic dosage ranges.
*See recommendations regarding transitioning to warfarin therapy in the full Prescribing Information.
Learn about treatments with Lovenox
in medically ill patients.
See efficacy information about
treatment with Lovenox in patients
with acute coronary syndrome.
Warning: spinal/epidural hematomas
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.