[Celia M]

Is anyone giving Lovenox IV, we have just had an MD order it and have not given it by this route and the MD could not give us much evidence other than other hospitals are giving it IV as a bolus when starting anticoagulant therapy. Thanks

[wendyp72]

Originally Posted by Celia M

Is anyone giving Lovenox IV, we have just had an MD order it and have not given it by this route and the MD could not give us much evidence other than other hospitals are giving it IV as a bolus when starting anticoagulant therapy. Thanks

We always give it sq in the abdomen. From what I understand, this is the only approved route.

[lee1]

Originally Posted by Celia M

Is anyone giving Lovenox IV, we have just had an MD order it and have not given it by this route and the MD could not give us much evidence other than other hospitals are giving it IV as a bolus when starting anticoagulant therapy. Thanks

Have you looked it up yourself??? How about your pharmacy???
Never heard of this route of administration. Only sq.

[New CCU RN]

We give an initiation dose of 30mg IV as a loading dose followed by the mg/kg dose subcutaneously.

Originally Posted by Celia M

Is anyone giving Lovenox IV, we have just had an MD order it and have not given it by this route and the MD could not give us much evidence other than other hospitals are giving it IV as a bolus when starting anticoagulant therapy. Thanks

[suzanne4]

Just because a physician has ordered it by that route, make sure that you have a policy in place to do so at your facility. And get it cleared by your pharmacy. Literature is changing all of the time, but in order to be covered by your facility, you have to follow what is in the Pharmacy Therapeutics documentation. If it hasn't been used like this at your facility before, the doctor must submit to the hospital Pharmacy and Therapeutics Committee for approval first. Don't get caught in the middle.

This was for the original poster..............

[New CCU RN]

Just wanted to add that we have been doing this for the last 3 years (giving the loading dose)

I am surprised to see how there are only a few others who are also practicing this.

It is a protocol, hospital approved, etc. for our ACS patients. We are a regional MI center.

[heart queen]

I was just a the lovenox site for reference. There is NO mention as to clinical trials or to dosing with IV.

http://www.lovenox.com/consumer/thrombosis/heparin1.do

I'm not refuting, or arguing with the posters stating that IV is used, simply stating that the drugs own site does not provide safe IV dosing or provide a recommended IV dose with clinical proof of the risks vrs. bennies.

Our facility is strictly sq, with reopro, integrillin and all the what not's... can anyone give me some clinical info as to WHY this would be preferred.... aside from quicker onset of action... but why not just the glycoproteins, heparin or thrombolysis... with the manufacturer not stating an IV use?

Is there new literature out ther? PLEASE share it, so we can improve our outcomes!

thanks all

[5scardiacnurse]

Originally Posted by Celia M

Is anyone giving Lovenox IV, we have just had an MD order it and have not given it by this route and the MD could not give us much evidence other than other hospitals are giving it IV as a bolus when starting anticoagulant therapy. Thanks

I work in a cardiac step down unit and I have only given it subq. All the literature I have ever seen only states subq as a route, not IV. Also, remember just because the doctor ordered it does not mean that it is necessarily right.

[papawjohn]

Hey Celia

An interesting trip through google-ville yielded an article in Journal of Clinical Pharmacology and Therapeutics (doesn't that sound like something to take to the beach house?!) about CONTINUOUS IV lovenox infusion. (A couple of episodes of GI bleeding--overall seemed pretty safe, they say.)

http://www.blackwell-synergy.com/doi...5.2710.00534.x

For the rest of the 4 or 5 items I scanned, lovenox was only cited as a SQ drug. (They were all quite strong about NO IM ADMINISTRATION.)

There is a good bit in there about IV bolus doses of 'unfractionated heparin'. I didn't study it enough to 'splain the difference between 'unfractionated' and 'low molecular weight' heparin.

The best advice is to follow the Hosp's policy, however.

Papaw John

[pricklypear]

I wrote the company a couple of months ago because we had some issues with the new ACS guidelines at my hospital. Our therapeutics committee had approved an order set that included the initial IV dose, then 1mg/kg SC Q12h. We never had any memos or anything about this, so everybody was confused. My problem was that some people were giving the IV dose, then waiting 12 hours to start the SC dose - which I thought had to be incorrect. Anyway, the company sent me some PDF files with studies using IV dosing, and the correct way to administer it (give SC immediately following IV dose).