Enoxaparin

INTRODUCTION

Indications

Prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE) in surgical and medical patients. Treatment of DVT (with warfarin). Prevention of ischemic complications (with aspirin) from unstable angina, non–Q-wave MI. Unlabeled Use: Systemic anticoagulation for other diagnoses.

Action

Potentiates the inhibitory effect of antithrombin on factor Xa and thrombin. Therapeutic Effects: Prevention of thrombus formation.

Adverse Reactions/Side Effects

CNS: dizziness, headache, insomnia. CV: edema. GI: constipation, nausea, reversible increase in liver enzymes, vomiting. GU: urinary retention. Derm: ecchymoses, pruritus, rash, urticaria. F and E: hyperkalemia. Hemat: bleeding, anemia, thrombocytopenia. Local: erythema at injection site, hematoma, irritation, pain. Misc: fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor symptoms of DVT (pain, swelling, warmth, redness) to determine if drug therapy is effective in preventing or reducing venous thrombosis. Request or administer objective tests (Doppler ultrasound) if symptoms increase.

• In patients with DVT, watch for signs of pulmonary embolism (shortness of breath, chest pain, cough, bloody sputum). Notify physician or nursing staff immediately if these signs occur.

• Assess for signs of bleeding and hemorrhage, including bleeding gums, nosebleeds, unusual bruising, black/tarry stools, hematuria, and a fall in hematocrit or blood pressure. Notify physician or nursing staff immediately if enoxaparin causes excessive anticoagulation.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention or vasodilation.

• Monitor signs of anemia, including unusual fatigue, shortness of breath with exertion, bruising, and pale skin. Notify physician or nursing staff immediately if these signs occur.

• Monitor signs of high plasma potassium levels (hyperkalemia), including bradycardia, fatigue, weakness, numbness, and tingling. Notify physician or nursing staff because severe cases can lead to life-threatening arrhythmias and paralysis.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

• Be alert for acute arterial or venous thrombosis caused by heparin-induced thrombocytopenia (HIT). Although the risk of HIT is lower compared with traditional heparin, enoxaparin may initiate an immune reaction in certain patients where antibodies attack circulating platelets. Although most cases of HIT are minor and asymptomatic, some patients may experience life- or limb-threatening platelet clots, resulting in myocardial infarction, ischemic stroke, acute leg ischemia, or venous thromboembolism. HIT can occur during and up to several weeks after heparin therapy. Any signs of increased clotting should be reported immediately.

• Assess injection site for pain, swelling, irritation, or bruising. Report prolonged or excessive injection-site reactions to the ...