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You are here: Home » eGM Resources » Health Information & Resources Portal|Home » RX Drug List (listed alphabetically) » Drug Reference (E's) » Enoxaparin




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.
Patients should be frequently monitored for signs and symptoms of neurological impairment. If neurologic compromise is noted, urgent treatment is necessary. 
The physician should consider the potential benefit versus risk before neuraxial intervention in patients anticoagulated or to be anticoagulated for thromboprophylaxis (see also WARNINGS, Hemorrhage, and DRUG INTERACTIONS).

Lovenox Injection is a sterile solution containing enoxaparin sodium, a low molecular weight heparin. It is available in: prefilled syringes (30 and 40 mg), graduated prefilled syringes (60, 80, and 100 mg), and ampules (30 mg). Each dosage unit contains 10 mg enoxaparin sodium per 0.1 mL Water for Injection. The solution is preservative-free and intended for use only as a single-dose injection. (See DOSAGE AND ADMINISTRATION and HOW SUPPLIED for dosage unit descriptions.)

The pH of the injection is 5.5 to 7.5, with an approximate anti-Factor Xa activity per dosage unit of 1000 IU per every 10 mg of enoxaparin sodium (with reference to the W.H.O. First International Low Molecular Weight Heparin Reference Standard). Nitrogen is used in the headspace to inhibit oxidation.

Enoxaparin is obtained by alkaline degradation of heparin benzyl ester derived from porcine intestinal mucosa. Its structure is characterized by a 2-O-sulfo-4-enepyranosuronic acid group at the non-reducing end and a 2-N, 6-O-disulfo-D-glucosamine at the reducing end of the chain. The substance is the sodium salt. The average molecular weight is about 4500 daltons. The molecular weight distribution is:

<2000 daltons £20%
2000 to 8000 daltons ³68%
>8000 daltons £15%

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