Lovenox IV & Acute Coronary Syndrome

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Specializes in Telemetry, ICU, Resource Pool, Dialysis.

Our hospital uses "clinical guidelines" which are preprinted orders for certain things. ACS is a very common one that we see everyday. One of the orders is Lovenox 30mg IV, then 1mg/kg SQ a 12h. Sometimes this is started in ER, the lovenox IV and SQ are both given before the patient arrives to the unit. I, and many of my coworkers have always assumed this was how it was meant to be given. An IV bolus, which acts quickly but only lasts a short time, followed immediately by a SQ dose which takes 2-4 hours to reach peak effectiveness.

My problem is, I found that there are some people (a pharmacist included) who believe the itent is to give the IV dose, then start the SQ 12h later. I talked to 1 cardiologist who said he doesn't order it IV - actually it was the PA, and he didn't know WHY the Dr doesn't like IV. Even the other pharmacists were clueless.

I could not find anything helpful in the PDR, or on our hospital medication site. I asked 2 ER docs who said they don't use the ACS orders because they don't believe Lovenox should be given IV. So, do any of you have any orders for Lovenox IV followed by SQ, and how is it given in your hospital? At the same time, or delayed? Also does anybody know how long until the IV form is ineffective?

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Specializes in Utilization Management.

Gee, I didn't know you could give Lovenox IV. Thought it was SC only.

http://www.lovenox.com/professional/about/administering.do

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Specializes in Telemetry, ICU, Resource Pool, Dialysis.
Gee, I didn't know you could give Lovenox IV. Thought it was SC only.

http://www.lovenox.com/professional/about/administering.do

Thanks, been there...nothing. It's like someone at work pulled this out of their ***. Actually, I have seen it recommended IV initially, then SC on other web sites, and for ACS. But no information on side-effects specific to IV use, how long it lasts, etc...

Before we had these specific ACS orders, we would occasionally give someone an IV bolus of Lovenox as they were heading to the cath lab in emergent cases. But that was rare.

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Specializes in Utilization Management.

I guess if you can't find it anywhere else, then call the company. I know their reps are more than happy to answer any questions.

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Specializes in Telemetry, ICU, Resource Pool, Dialysis.

Yes, that was my next step! Thanks!

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Specializes in ER.

I found one article from 2002 that talked about clinical trials in which IV Lovenox was given for ACS...but it talks about it only being given in the ER if the patient is going straight to the cath lab for a PCI or for an admitted patient in which their last dose of SQ Lovenox was given greater than 8 hours prior to their intervention...I personally have never given it...We usually give them a IIb IIIa inhibitor and go right to the lab...

Clinical Trial

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Specializes in Telemetry, ICU, Resource Pool, Dialysis.

I'm waiting for a response from the drug co. #1 the docs need to clarify the order. By biggest problem is that I assume, from the way the order is written, that the 1st SC dose should be given immediately following the IV. This is how we used to give heparin. IV bolus followed immediately by ______units SC. I know Lovenox and Heparin are not the same thing, although close. The principle is the same. IV acts immediately, SC takes 3-5 hours to reach peak effectiveness (for Lovenox) Some of the nurses I work with are waiting up to 12 hours to start the SC dose. If we have a patient who is strongly suspected to be having a thrombolytic event of some kind, or a plaque buildup so large that even the smallest clot could obstruct it completely, and the IV dose is ineffective within a small amount of time, what are we doing for the patient if the SC dose is delayed? I'm hoping the drug co can give me info on how long the IV dose is therapeutic.

Thanks for the links!:)

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Specializes in ER.
I'm waiting for a response from the drug co. #1 the docs need to clarify the order. By biggest problem is that I assume, from the way the order is written, that the 1st SC dose should be given immediately following the IV. This is how we used to give heparin. IV bolus followed immediately by ______units SC. I know Lovenox and Heparin are not the same thing, although close. The principle is the same. IV acts immediately, SC takes 3-5 hours to reach peak effectiveness (for Lovenox) Some of the nurses I work with are waiting up to 12 hours to start the SC dose. If we have a patient who is strongly suspected to be having a thrombolytic event of some kind, or a plaque buildup so large that even the smallest clot could obstruct it completely, and the IV dose is ineffective within a small amount of time, what are we doing for the patient if the SC dose is delayed? I'm hoping the drug co can give me info on how long the IV dose is therapeutic.

Thanks for the links!:)

Here's what I found for dosing guidelines...I'm still looking for you for side effects and whatnot...

Lovenox

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Specializes in Telemetry, ICU, Resource Pool, Dialysis.

Awesome!! They sent me back some stuff right away. It's not "approved" for IV use, but has been used in clinical trials and is recommended for ACS and DVT. Looks like the SC dose is supposed to be given within 5 minutes of the IV bolus. It's therapeutic half life is 2.6 hours. If anybody is interested, I'll email the PDF files they sent me. Basically, the side effects are the same as SC - bleeding!! Thanks mommatrauma for your research!

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Im interested. Thanks

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Awesome!! They sent me back some stuff right away. It's not "approved" for IV use, but has been used in clinical trials and is recommended for ACS and DVT. Looks like the SC dose is supposed to be given within 5 minutes of the IV bolus. It's therapeutic half life is 2.6 hours. If anybody is interested, I'll email the PDF files they sent me. Basically, the side effects are the same as SC - bleeding!! Thanks mommatrauma for your research!

i too give lovenox iv bolus followed by subg inj but only in the er...please email the pdf files for reference thanks!!!

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Hello all,

This really interested me as I have given IV lovenox on a few occasions on the step-down unit I worked on. There was only one cardiologist that was known to order it for ACS. There was never any info on how soon to give the SQ dose afterward, however, we had 24 hour pharmacists and when I called one regarding this matter, he told me I should give the SQ dose upon the pt being admitted (if it was given in the ER already), which was usually the case.

The first time I had saw an order for IV lovenox, I thought it was an error. It's interesting to hear from others who have given it IV. Just thought I'd comment. Thanks. :)

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