lovenox..and coumadin - page 2

My mother had a huge PE .. they are sending her home on both lovenox and coumadin...I don't understand why both.. when my mother asked they said that her daughter (me :uhoh3: ) could explain it... Read More

  1. by   rn undisclosed name
    I'm not going to repeat what was said above, but, I did want to add that when we have patients going home on Lovenox they get sent home with the "Lovenox kit". It is from Lovenox and has a dvd to explain everything to the patient/family. Not a substitute for teaching the patients but every little bit helps. Plus there are booklets in there for them. Hopefully you received that. Sorry for the care your mom received in the hospital. That is just unacceptable.
  2. by   lsyorke
    Quote from suemom2kay
    As far as I know, Lovenox (non-fractionated heparin, is NOT monitored via PTT).
    Yup!! that's the advantage of Lovenox..no blood work required. The downside is the cost. We are using lovenox almost exclusively now, since patients can go home on it, instead of sitting in the hospital waiting for a therapeautic INR on coumadin.
  3. by   Tweety
    Quote from suemom2kay
    As far as I know, Lovenox (non-fractionated heparin, is NOT monitored via PTT).
    Lovenox is weight-based and not monitored via PTT. It's ususally given on a short term basis. You do have to monitor platelettes as thrombocytopenia can be a problem.
  4. by   Tweety
    Quote from LisaRn21
    Thanks guys! I get it now that would make total sense......and yes it is unacceptable so is a ton of stuff that has happened in the past 2 weeks....ie the room not being cleaned before she was placed there....insulin being given without checking the bs (the cna charted it so its done says the nurse...yet I didn't leave the bed side and she didn't do it while I was there), telling my mom she stunk cause she hadn't bathed in a week (well duh! she was sedated and intubated in the ICU ... geez) oh and the list goes on ... never ever would have thought this from a top ten hospital, needless to say the nurse manager and I had a little chat ... but thanks for the info guys!!
    Sounds dreadful. I'm sorry for the experience. I hope she gets well soon.
  5. by   Tweety
    Quote from kellykul
    I'm not going to repeat what was said above, but, I did want to add that when we have patients going home on Lovenox they get sent home with the "Lovenox kit". It is from Lovenox and has a dvd to explain everything to the patient/family. Not a substitute for teaching the patients but every little bit helps. Plus there are booklets in there for them. Hopefully you received that. Sorry for the care your mom received in the hospital. That is just unacceptable.
    We never have enough kits to go around. We are constantly bugging the drug reps to bring more kits. Sad.
  6. by   Roy Fokker
    Quote from mced
    Rat poison (coumadin) takes longer to reach a therapeutic level than lovenox. Once her INR is around 2-3 they will probably d/c the lovenox. In the meantime the lovenox helps to prevent any further clot development.
    That could be part of the reason.

    I've also had patients who have significant cardiac history (a-fib etc.) who get BOTH Coumadin AND Lovenox post surgery (most of these patients are post-ortho patients).

    The reasoning is that the Coumadin is more for treating underlying cardio-condition and the Lovenox is for post-op therapeutics. I've had an ortho surgeon take 15 minutes of his time to explain it to me (using hastily drawn figures and all!)

    But in these cases, you'll almost always find that the patient was already on the Coumadin before surgery.

    And I agree with everyone else - "Your daughter can better explain it to you" is NOT an appropriate response! :stone

    cheers,
  7. by   CritterLover
    Quote from suemom2kay
    as far as i know, lovenox (non-fractionated heparin, is not monitored via ptt).


    lovenox does not have to be monitored with ptt, but it can be monitored with ptt.

    the reason is that the studies with lovenox showed a very predictable relationship between weight-based dosing and ptt levels. the same is not true with regular heparin with respect to ptt, nor is it true with coumadin with respect to pt/inr. (that is, while a certain weight-based dose of lovenox will give a predictable ptt, a certain dose of heparin will not give a predictable ptt, and a certain dose of coumadin will not give a certain pt/inr.)

    had a pt this am who has been on coumadin and lovenox. inr was 1.8 (not quite yet therapeutic), ptt was 83.5 (therapeutic). the levels were drawn because she was having a minor procedure done, not because of a dosage question.
  8. by   medsirgrn
    Patients that have experienced PE or have a history of chf,dvt, a-fib or placement of artifical devices in the body such as pacemakers are usually placed on coumadine.What coumadine and lovenox does, it prevents the formation of blood clots and keep the blood flowing smoothly.Lovenox is usually given as a profilaxis treatment along with coumadine for patient that are high risk.So in your mothers case she may have a high risk of developing clots which is why she recieves both medications.Patients are sent home with the lovenox kit which will instruct them on how to administer the medication.I am surprised that the doctor was not willing to teach your mother about the drugs and passed on the responsibility to you.People have blead to death, these are very serious drugs.
    Last edit by medsirgrn on Jan 25, '07
  9. by   CritterLover
    Quote from medsirgrn
    patients that have experienced pe or have a history of chf,dvt, a-fib or placement of artifical devices in the body such as pacemakers are usually placed on coumadine.what coumadine does, it prevents the formation of blood clots and lovenox attacks existing clots and keep the blood flowing smoothly.lovenox is usually given as a profilaxis treatment along with coumadine for patient that are high risk.so in your mothers case she may have a high risk of developing clots which is why she recieves both medications.patients are sent home with the lovenox kit which will instruct them on how to administer the medication.i am surprised that the doctor was not willing to teach your mother about the drugs and passed on the responsibility to you.people have blead to death these are very serious drugs.
    no, lovenox does not "attack" the existing clot. heparins (i'm including lovenox) and coumadin both work by preventing the formation of blood clots/keeping the clot from growing. however, they work by inhibiting different clotting factors and have very different kinetics.

    the only drugs that break down clots are thrombolytics -- such as tpa. your body produces its own tpa, and will eventually break down the clot. anticoagulants assist your body in breaking down the clot by keeping the clot from getting bigger, thus making the problem manageable for the body. it takes a long time, though, for the body to break down the clot.
  10. by   medsirgrn
    Thanks for the correction and the thread has been edited accordingly.Thank you.
  11. by   loriannlpn
    Heparin is the buster
    Coumadin is the preventor
  12. by   group_theory
    The reason why you start on both lovenox and coumadin is because starting coumadin will make the blood initially hypercoagulable ... and thus you need either lovenox or heparin to prevent further clot formation.

    Coumadin works by inhibiting Vitamin-K dependant factors, such as II, VII, IX, and X, along with Protein C and Protein S. Protein C and Protein S responds a lot more quickly to decreased Vitamin K caused coumadin compare to other Vitamin-K dependant factors. As a result, the patient is in a hypercoaguable state. It is only when factors II, VII, IX, and X are decreased is when the patient goes from the hypercoaguable state to an anticoaguable state (and hence why it takes several days for the INR to be elevated)

    Lovenox is given in the meanwhile to keep the patient in an anticoaguable state until coumadin kicks in. Lovenox (and heparin) works by a completely different mechanism (mainly by activating antithrombin III) and thus have an immediate effect by inhibiting thrombin and Factor Xa.


    Neither coumadin or lovenox is intended to remove the clot either in a DVT or a PE ... it is to prevent further clot formation. The body will take care of the clot by slowing removing it using its own thrombolytics, but it usually take a while ... that's why people with DVT or PE will have to be on coumadin for months on end
  13. by   Roy Fokker
    Quote from loriannlpn
    heparin is the buster
    coumadin is the preventor
    heparin doesn't "bust" clots. along with coumadin, heparin "prevents" clots.

    see:

    Quote from critterlover
    no, lovenox does not "attack" the existing clot. heparins (i'm including lovenox) and coumadin both work by preventing the formation of blood clots/keeping the clot from growing. however, they work by inhibiting different clotting factors and have very different kinetics.

    the only drugs that break down clots are thrombolytics -- such as tpa.
    and:
    Quote from group_theory
    neither coumadin or lovenox is intended to remove the clot either in a dvt or a pe ... it is to prevent further clot formation.
    cheers,

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