As stated in "Mosby's 2010 Nursing Drug Reference," Lovenox (enoxaparin sodium) is a low-weight based heparin used to prevent pulmonary embolism and deep vein thrombosis in those at risk for blood clots. Hospitals also typically use Lovenox as a prophylactic treatment for patients with decreased mobility while they are receiving nursing care. Patients receiving Lovenox injections are at risk for bruising at the injection sites, hemorrhage and thrombocytopenia (decreased platelet count and clotting abilities).
Severe Bruising
Lovenox is administered through injections in the abdominal region. Reactions to the injection include itching, burning and a cold sensation. Patients might be tempted to rub the area to relieve these symptoms but must be cautioned that any vigorous rubbing may cause severe bruising. A better method for relieving any irritation is to lightly trail the fingertips over the area until the sensation subsides. If patients are self-administering the injections, they should not give the injection in already bruised tissue, as this may increase the area of the bruise. Rotation of the injection sites is helpful in preventing large black-and-blue tissue.
Hemorrhage
Although uncommon, an increased incidence of hemorrhage is possible while on Lovenox. Any person also taking a non-steroidal anti-inflammatory drug is at higher risk for prolonged clotting times. Patients who develop slight cuts and scrapes are advised that longer-than-normal clotting times may occur because of decreased platelet count. Because Lovenox is used to decrease the risk of the formation of blood clots, what would usually be an inconvenient cut may quickly become a more serious hemorrhage. Should an event occur in which major blood loss is anticipated, the patient should seek immediate medical treatment. Abruptly discontinuing this drug does not immediately lessen a patient's risk for hemorrhage. According to "PDR Nurse's Drug Handbook 2010," anticoagulant effects could continue two to four days after cessation.
Other Complications
Lovenox has been shown to decrease hemoglobin and hematocrit in blood values. Patients may develop anemia and feel lethargic, and breathing may become more labored. Any patient experiencing such symptoms should report them to their doctor to have a complete blood count drawn.
Patients may also experience increased nausea while on Lovenox therapy. Any patients at risk for bleeding ulcers should inform their doctor before beginning injection therapy so they may be closely monitored for any signs or symptoms of an increase in gastric compromise.
Black and tarry stools are possible; an indication that blood is being passed through the stool. Report any changes in stool color or odor to a doctor.
References
- "PDR Nurse's Drug Handbook 2010"; Thomson Reuters and Alexander Ivy; 2009
- "Mosby's 2010 Nursing Drug Reference"; Linda Skidmore-Roth, 2009
