Enoxaparin (Lovenox®)

Important Information

Blood clotting helps heal injured blood vessels, but too much clotting can be harmful. Clots can form in the heart, arteries, or veins. A clot in a large vein is called a deep vein thrombosis (DVT). Blood clots can block blood flow and cause pain and swelling. If a clot travels to the lungs, it can cause a pulmonary embolism (PE).

Enoxaparin (also known as the brand name Lovenox®) is a medicine that helps prevent blood clots, keeps blood clots from getting bigger and from traveling to the lungs. It does not break down clots. It is a clear liquid given as an injection under the skin every 12 hours (twice a day). Enoxaparin can be given in two ways:               

1. Using insulin syringes to draw up from a multiple-dose vial

2. In pre-filled syringes. 

Your healthcare team will tell you which way you will give your child’s dose.

Patient Instructions

Enoxaparin storage

• Store at room temperature. Do not put the medicine in the refrigerator or freezer or out in the heat. 

• An open vial may be used for as long as 28 days after it is opened. Store the vial in a clean container to limit contamination.

• Use up the medicine in one vial before opening a second vial. 

• Do not use a vial that is cloudy or appears abnormal.

Using insulin syringes to measure enoxaparin

• Insulin syringes are marked in units. Because 1 mg of enoxaparin is the same amount of medicine as 1 unit, we can use the insulin syringe to draw up enoxaparin using the unit markings. Example: 9 mg enoxaparin dose = 9 units on an insulin syringe.
  
  Check to make sure you have the correct syringe size for the dose prescribed. Refer to the subcutaneous injection instructions handout for steps on how to draw up a dose from a multi-dose vial and how to inject enoxaparin.

   

  Dose	Syringe Size
  25mg or less	30 unit (0.3 ml)
  26-45mg	50 unit (0.5 ml)
  46-100mg	100 unit (1 ml)

30-unit insulin syringe for doses 25mg or less	50-unit insulin syringe for doses 26-45mg	100-unit insulin syringe for doses 46-100mg

Using pre-filled syringes to measure enoxaparin

• If you are giving all of the dose in the pre-filled syringe, follow the subcutaneous injection instructionsfor steps on how to inject enoxaparin.

• If you are giving less than the dose in the pre-filled syringe, you will subtract the prescribed dose from the pre-filled dose. 

  • Example: Prefilled syringe contains 60 mg/0.6 mL. Prescribed dose is 50 mg/0.5 mL.   
    Dose:  60 mg – 50mg = 10mg
    Volume: 0.6 mL - 0.5 mL = 0.1 mL

  • Squirt out the additional 0.1 ml from the syringe before giving injection

  Refer to the subcutaneous injection instructions handout for steps on how to measure the dose in a prefilled syringe and how to inject enoxaparin.

Missed doses

• If you miss your dose, take it as soon as possible on the same day. Do not take a double dose or any extra medicine to make up for a missed dose.

• If the remembered dose will be more than two hours late, call us to make a plan to get dosing back on schedule. Too much enoxaparin may cause you to bleed. Too little may let a clot form.

• Call for refills at least 3 to 5 days before you are out of enoxaparin and needles. 

Blood tests

• A heparin anti-Xa blood test helps decide the best dose of enoxaparin for you. This blood test should be drawn about 4 hours after you’ve had your enoxaparin injection (target time range is 3.5 to 5 hours.). Remember this timing rule when you plan your trip to the lab to get the test done.

• You will be instructed on when to get an anti-Xa based on how long you’ve been on enoxaparin, any bleeding symptoms or changes that could impact the dose, such as weight gain.

• Follow up with us to get results of heparin anti-Xa results.

Enoxaparin and other medicine

• Check with us before starting any new medication or herbal product while receiving enoxaparin. 

• Unless ordered by your healthcare team, do not take aspirin, clopidogrel (Plavix®), naproxen (Aleve®), ibuprofen (Motrin® or Advil®) or medicines that contain those drugs while taking enoxaparin.  Taking them together increases the risk of bleeding. 

Safety guidelines

There is an increased risk of bleeding while on enoxaparin. Follow these guidelines to minimize the risk of bleeding.

• After giving enoxaparin, apply pressure to the injection site until the bleeding stops or for at least 2 minutes, whichever is longer. 

• Report any bleeding, fall or trauma to us immediately. 

• Notify us if you are getting dental work or other invasive procedures including surgery or immunizations so we develop a plan before these procedures. 

• Use seatbelts, safety straps in highchairs and strollers, stair gates, helmets and other safety equipment. 

• Avoid contact sports or activities that have a high risk of head trauma. 

Call the Hemostasis and Thrombosis Center if you:

• Have abnormal bleeding (for females, this includes heavy or prolonged periods) 

• Have symptoms of a clot or PE (pulmonary embolism) or stroke

• Are injured or experience trauma

• Cannot make a scheduled visit

Hemostasis and Thrombosis Center 

CHOP Main patients:  8:30a-5p, Monday-Friday: 215-590-3058

Voorhees patients:  8a-4:30p, Monday-Friday: 856-435-7502  

King of Prussia patients:  8a-4:30p, Monday- Friday: 267-425-3320  

Weekends, holidays and every day after 5:00pm, all patients:  215-590-1000, ask the hospital operator for the hematologist on call.

For non-urgent issues, send your team a message in the MyCHOP portal 

Reviewed October 2024 by Kaitlin Bates, RN, BSN, Jennifer Colt, RN, BSN and Char Witmer, MD