Switching from Heparin to Lovenox

[Doctor Jay 23]

I'm working with a gestational patient dx with Lupus. She is currently on 15,000U Heparin bid. We may want to switch her to Lovenox. Does anyone know what dosing precautions or procedures necessary to do this?

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[spacecowgirl]

For prophylaxis?

http://chestjournal.chestpubs.org/content/133/6_suppl/844S.full.pdf

-Prophylactic LMWH:
dalteparin 5,000 U subcutaneously q24h
tinzaparin 4,500 U subcutaneouslyq24h
enoxaparin 40 mg subcutaneously q24h (although at extremes of body weight modification of dose may be required).

–Intermediate-dose LMWH:
dalteparin 5,000 U subcutaneously q12h
enoxaparin 40 mg subcutaneously q12h.

–Adjusted-dose LMWH: weight-adjusted, full treatment
doses of LMWH, given once or twice daily
dalteparin 200 U/kg
tinzaparin 175 U/kg qd
dalteparin 100 U/kg q12h
enoxaparin 1 mg/kg q12h

 

[Quiksilver]

I'm working with a gestational patient dx with Lupus. She is currently on 15,000U Heparin bid. We may want to switch her to Lovenox. Does anyone know what dosing precautions or procedures necessary to do this?

Well the question is why do you want to switch to LMWH? If it ain't broke don't fix it, the two drugs are equivalent in preventing VTE. Remember if there is surgery planned, this might not be the best option because the half life is longer and only partially reversed by protamine when compared to heparin.

 

[Doctor Jay 23]

Well the question is why do you want to switch to LMWH? If it ain't broke don't fix it, the two drugs are equivalent in preventing VTE. Remember if there is surgery planned, this might not be the best option because the half life is longer and only partially reversed by protamine when compared to heparin.

Well, this was kind of a hypothetic question proposed to me by my preceptor. There are no currently reasons to switch. Just wanted some feedback.
🙂

 

[SomeGuy]

Use a preservative free formulation that doesn't have benzyl alcohol in it.

 

[Pharmavixen]

There's the lower risk of HIT from LMWH, and also easier to discharge the pt home after self-administration is taught.

Though if the pt has lupus, how's her renal function?