Prescribing SC heparin vs. SC lovenox

Specialties NP

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Specializes in ACNP-BC.

Hi. I'm a med/surg RN & an acute care NP student and I have a question that's been on my mind for a while now. How do precribers decide if they will prescribe SC heparin vs. SC lovenox for a patient? Why choose one versus the other, if we're talking about giving either SC? Does it have to do with the molecular weight of them? I haven't taken my advanced pharmacology class yet (will start it in two weeks!) so I was hoping you experienced NPs out there would know this. Thanks! :)

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
Hi. I'm a med/surg RN & an acute care NP student and I have a question that's been on my mind for a while now. How do precribers decide if they will prescribe SC heparin vs. SC lovenox for a patient? Why choose one versus the other, if we're talking about giving either SC? Does it have to do with the molecular weight of them? I haven't taken my advanced pharmacology class yet (will start it in two weeks!) so I was hoping you experienced NPs out there would know this. Thanks! :)

SC Heparin is used for DVT prophylaxis alone. The dose is usually 5000 Units Q 12 hrs but some experts are now saying that 5000 Units Q 8 hr dosing is more effective. IV drip Heparin (or unfractionated Heparin) is used for treatment of DVT or PE as well as a bridge to Coumadin therapy for DVT, PE, and A fib. Lovenox (or low-molecular weight Heparin) may be used for the same purposes but it's only given SC regardless of the reason for its use. For DVT prophylaxis, it is dosed at 30 mg q 12 hours. For treatment of DVT or PE or as a bridge to Coumadin the dose is 1 mg/kg q 12 hours.

The choice of using one over the other depends on the prescriber's and hospital preference. Lovenox is more expensive since it is a brand name. Heparin has been around forever so it is cheap. Lovenox is more convenient to administer since it is SC. A patient can be sent home on Lovenox but not Heparin IV because of the need for PTT monitoring with Heparin IV.

I had a brief stint as an NP in in-patient spinal cord injury rehab. The attending I worked with prefers Lovenox for DVT prophylaxis over Heparin SC because she says the literature recommends Lovenox over Heparin for patients at higher risk for DVT and PE. The spinal cord injury population are usually quadriplegic or paraplegic so they are at high risk for DVT and PE.

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Specializes in Education, FP, LNC, Forensics, ED, OB.

Advantages:

  • Decreased incidence of heparin-induced thrombocytopenia
  • Less bleeding than with unfractionated heparins
  • Overall more cost-effective due to decreased length hospital stay
  • No monitoring needed (exception renal failure)
  • OP tx for venous thrombosis

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Let us not forget that heparin is used for the people with renal insufficiency or renal disease. Lovenox has a longer half life and isn't the treatment of choiice if one might have to emegently go the the OR.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
Let us not forget that heparin is used for the people with renal insufficiency or renal disease. Lovenox has a longer half life and isn't the treatment of choiice if one might have to emegently go the the OR.

True, but Lovenox can be renally dosed at 1 mg/kg q day instead of q 12 hours.

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advantages:

  • decreased incidence of heparin-induced thrombocytopenia
  • less bleeding than with unfractionated heparins
  • overall more cost-effective due to decreased length hospital stay
  • no monitoring needed (exception renal failure)
  • op tx for venous thrombosis

another advantage of the low-molecular weight heparin (i call 'em lo-mo's) is

low molecular weight means less binding to protein and other cellular binding which means less activation of osteoclasts

osteoclasts break down bone. if osteoclasts are activated means osteopenia/osteoporosis but if there is less activation of osteoclasts, means $ osteoporosis

heparin has one big advantage over lo-mo's - its anticoagulant effect can be reversed essentially completely with a protamine sulfate. in the lo-mo's, you can reverse only 40-50% of the anticoagulation with a protamine sulfate. so if you have a patient where a bleed out would be a problem, or the patient has increased risk of hemorrhage (ulcerative colitis, hemorrhagic stroke), you may want to think heparin rather than a lo-mo.

finally, a warning:

don't use lovenox with a concurrent spinal/epidural anesthesia or puncture because of risk of a epidural or spinal hematoma forming.

also lo-mo's have not been tested yet to be used long term with things like valve replacement

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that was super helpful.. thank you.:nurse:

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