Should a Patient on Lovenox be Monitored?

[Duff Man]

Hey ladies and gentlemen, when someone is on 1mg/kg lovenox for ACT, does it require monitoring by a hematologist or a clinic for PT time or something like that? My wife says she's constantly cold, her temp is at 96.5 f... I'm starting to think this is something that she should be seeing a hematologist for.

What say you?

 

[Nancy]

Why is she on Lovenox and not Coumadin?

 

[Ross]

Lovenox no, Heparin yes. With the Lovenox, you aleady know the dose required based on the weight of the individual and it's short acting. Heparin requires blood draws and adjustments every 6 hours and sucks big time.

 

[Duff Man]

Why is she on Lovenox and not Coumadin?

I guess Lovenox doesn't cross the placenta, or so they say... and Coumadin has been linked to fetus facial deformities.

Lovenox no, Heparin yes. With the Lovenox, you aleady know the dose required based on the weight of the individual and it's short acting. Heparin requires blood draws and adjustments every 6 hours and sucks big time.

Sweet! Thanks for the info. This is a whole new world for me.

Just out of curiosity, why do they replace Coumadin with Lovenox when they're having a surgery? I know it's shorter acting, but it still has an effect like 24 hours after an injection i think...

 

[KristyW]

Just out of curiosity, why do they replace Coumadin with Lovenox when they're having a surgery? I know it's shorter acting, but it still has an effect like 24 hours after an injection i think...

Aaron,

I think the effect is only 12 hours. That's why 2 shots a day. I could be wrong tho.

 

[ALCapshaw2]

Just out of curiosity, why do they replace Coumadin with Lovenox when they're having a surgery? I know it's shorter acting, but it still has an effect like 24 hours after an injection i think...

Surgeons want the blood to be at normal clotting levels during and shortly after surgery therefore they recommend going OFF Anti-Coagulants (Coumadin / Warfarin) and Anti-Platelets (aspirin, plavix) several days in advance of surgery.

They use Lovenox (or Heparin in-hospital) for BRIDGING specifically because it is both Fast Acting and Short Acting, i.e. protection is almost immediate following injection and lasts 12 hours. Most surgeons prefer that Lovenox be discontinued 24 hours before surgery (and many prefer it to be delayed 24 hours after surgery to let their incisions begin heal).

Coumadin / Warfarin is usually started several hours after surgery but may take several Days to become fully effective (i.e. INR is in range).

'AL Capshaw'

 

[Duff Man]

Thank you for the insight guys.

This is a pretty awesome (and amazingly expensive) drug. Too bad there's almost nothing else like it. I did find some info that says once a day is about as effective for the prevention of DVT and PE as twice a day injections.

 

[Jkm7]

Duff Man....


I'm sorry I've forgotten...... would you remind me?

I know your wife is expecting... Congratulations!!

What was the reason for her taking coumadin? Mechanical valve?

 

[Ross]

Yes it's 12 hours per injection. I still have 3 syringes left from my dental nightmare.

Strangely, I miss plunging that little needle into my belly. It was a source of comfort to me.

 

[Duff Man]

Duff Man....


I'm sorry I've forgotten...... would you remind me?

I know your wife is expecting... Congratulations!!

What was the reason for her taking coumadin? Mechanical valve?

Thank you! I love how everyone congratulates us.. it's not like it was very hard to accomplish. Seriously, for some reason I thought it would take like 6 months to a year. You always hear about people trying forever.

She has a chronic DVT in her femoral artery (or vein?) and she had a pulmonary embolism as a result of the DVT breaking off and hitting her lung. She started birth control like 5 or 6 months before she got the DVT, so we're almost certain that was the cause.

When a woman gets pregnant the hormones that are basically the same as birth control except in an even higher concentration are present in the body. Because my wife had her blood clot due to the birth control hormone, we're giving her lovenox as a prophylactic against another DVT.

It scares the hell out of me that she's injecting herself with this drug and she's got our child in her, but it's even scarier to think how risky it would be without it.

 

[Ross]

Thank you! I love how everyone congratulates us.. it's not like it was very hard to accomplish. Seriously, for some reason I thought it would take like 6 months to a year. You always hear about people trying forever.

All mine had to do was look at me and it was done. Pretty scary actually. No wonder she didn't let me alone around other females back then.

 

[Jkm7]

Thanks, Duff Man. The reason I asked was I knew 'mechanical valve' just didn't sound right to me.

It is scary...... but more scary without the drug. Doesn't sound as though there's any choice at all. Too big a risk to chance not taking it.

Of course you know everyone here wishes you, your wife and baby the very, very best.
We'll enjoy following along the pregnancy and will be happy to hear when your baby is safely born....that Mom and baby are fine.

 

[Duff Man]

All mine had to do was look at me and it was done. Pretty scary actually. No wonder she didn't let me alone around other females back then.

hahahahaha... I know exactly what you mean. I think we hung our coats on the same coat rack and kapow!

Oh, btw, pregnant women are not very happy go lucky.

 

[Dina]

Hey ladies and gentlemen, when someone is on 1mg/kg lovenox for ACT, does it require monitoring by a hematologist or a clinic for PT time or something like that? My wife says she's constantly cold, her temp is at 96.5 f... I'm starting to think this is something that she should be seeing a hematologist for.

What say you?

When I was on Lovenox(for several months) I had chills. So much that I was
constantly checking my temp to rule out fever,at times it would be low grade
like 99.0-99.8.I thought I had infection for quite a while,but I later found that
one of the side effects of Lovenox is fever.I don't know the mechanism though.
Also ,I was never monitored while at home on Lovenox,but in the hospital
PTT's were done almost everyday.
Wishing you guys well-Dina