Lovenox same day post-op?

Nurses Medications

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I know it's on a case by case basis but for your run of the mill lap chole type patient, lovenox is safe same day post op right? That's what I've been told, but then the other day I tried to go pull lovenox for a post op pt and it wasn't on the pyxis profile. When I called pharmacy about it, they said they 'always' start lovenox first day post-op, not same day. Sooo whats this now? Lovenox, good to give same day post-op or no?

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Specializes in Family Medicine.

We don't give it until post-op day 1. One time, a nurse in PACU gave my patient 150 mg and I couldn't stop shaking my head. I had to transfer her to ICU because she was gushing blood and having a hard time breathing (cervical fusion).

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Specializes in Trauma Surgical ICU.

We don't restart until post op day 1 or maybe 2 or later depending on the pts. Most are post op day 1 for normal no complications type surgery pts.

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Specializes in PACU, pre/postoperative, ortho.

Our ortho pts get the first dose 12 hrs after surgery.

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Had the surgeon prescibed Lovenox for her/his patient? I'm not sure why the pharmacist told you that Lovenox is always started the first post operative day. There are so many factors that affect that decision. Type of surgery, type of patient (VTE risk factors).

I can't tell you what's right or wrong though, only what I've experienced. You need to find out what the guidelines are at your facility.

I know I've seen laparoscopic cholecystectomi patients who were started on their lmwh therapy the day before surgery and also received a shot on the same day as the surgery (evening). The doses of Enoxaparin/Lovenox I'm accustomed to when given prophylactically are typically 20 or 40 mg sc.

Here is some general information on the topic that might be helpful?

http://www.sages.org/publications/guidelines/guidelines-for-deep-venous-thrombosis-prophylaxis-during-laparoscopic-surgery/

Noyesno, I'm curious. Why did the PACU nurse administer 150 mg? Was it ordered or was it a med error? That's a dose I've only seen when treating existing blod clots (1.5 mg/kg if I recall correctly) , never as prophylaxis. I'm far, far :confused: from a coagulation expert though.

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We routinely give subq heparin in Preop holding to abdominal cases. Our pharmacological vte prophylaxis is generally started immediately postop unless they have an epidural.

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Depending on the case, pts history, and surgery along with the dosage, I have seen lmwh given same day post op but there is usually a note to start 13 hrs post op. I will say that I don't think you can use the word "always" when it comes to nursing, meds, pt care, etc.

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