Lovenox and Eliquis are approved in the U.S. for the prevention of venous thromboembolism (VTE), a condition that includes deep vein thrombosis (DVT) and pulmonary embolism.
Lovenox and Eliquis can also be used to prevent blood clots, especially after a surgery such as knee surgery or hip replacement surgery. Other risk factors for blood clots include bed rest after surgery, a family history of blood-clotting disorders, pregnancy, obesity, smoking, and cancer.
Here we will explain how they work, their similarities and differences, their side effects, and more. This should provide you with the basics to better understand your options.
What is Lovenox?
Lovenox is an FDA (U.S. Food and Drug Administration) approved medication manufactured by Sanofi-Aventis. It is a low molecular weight heparin anticoagulant therapy used to treat thromboembolic events such as:
- Prophylaxis of deep venous thrombosis (DVT) in abdominal surgery, hip replacement surgery, knee replacement surgery, or patients with severely restricted mobility during acute illness
- Inpatient treatment of acute DVT with or without pulmonary embolism
- Outpatient treatment of acute DVT without pulmonary embolism
- Prophylaxis of ischemic complications of unstable angina and non-Q wave myocardial infarction [MI]
- Treatment of acute ST-segment elevation myocardial infarction managed medically or with subsequent percutaneous coronary intervention
Blood clots are clumps of blood that happen when some of your blood turns from a liquid to a gel-like substance. Blood clotting is usually good for you. If you cut yourself, your blood clots to block the cut and to stop the bleeding. However, in some situations, your blood can clot within veins inside your body. This can block the flow of blood, and cause swelling and pain around the clot. If the blood clot moves through your body, it can block the flow of blood to your lungs, causing a pulmonary embolism, which can be fatal. If the clot blocks the flow of blood to your brain, it can cause a stroke.
Lovenox is available in injection form, in the following doses: Prefilled syringes: 30 mg/0.3 mL, and 40 mg/0.4 mL, Graduated prefilled syringes: 60 mg/0.6 mL, 80 mg/0.8 mL, and 100 mg/1 mL, Multiple-dose vials: 300 mg/3 mL, and 150 mg/mL, Graduated prefilled syringes: 120 mg/0.8 mL, and 150 mg/1 mL.
You take Lovenox by injecting it under your skin (subcutaneous injection), using a pre-filled syringe. The active ingredient in Lovenox is called enoxaparin sodium. It’s a heparin medication that helps to treat blood clots or prevent them from happening by disrupting the clotting process. A complex chemical process causes your blood to clot. One step of this process is controlled by an enzyme called clotting factor Xa. Enoxaparin sodium stops your blood from clotting by deactivating clotting factor Xa. It stimulates a protein that’s already in your blood, called antithrombin, to attach to clotting factor Xa, stopping it from working. This disrupts the clotting process and makes it harder for your blood to form clots.
Lovenox has a half-life of up to 7 hours, and its anticoagulant effects last up to 12 hours. Due to this and its predictable effects, Lovenox does not need extensive monitoring or supervision.
What is Eliquis?
Eliquis is an FDA (U.S. Food and Drug Administration) approved medication manufactured by Bristol-Myers Squibb and Pfizer. Eliquis is an oral anticoagulant, a type of drug that stops blood clotting (thromboprophylaxis). This medication is used to prevent blood clots from forming in people who have:
- Nonvalvular atrial fibrillation (an irregular heartbeat not caused by a heart valve problem) and who have other clotting risk factors
- Had hip or knee replacement surgery
It’s also used to treat blood clots in the legs (deep vein thrombosis) and lungs (pulmonary embolism), and to stop blood clots from reoccurring in these places.
The active ingredient in Eliquis is an anticoagulant called apixaban. Apixaban is a highly specific factor Xa inhibitor. It has no direct effect on platelet aggregation, but indirectly inhibits platelet aggregation induced by thrombin. By inhibiting FXa, apixaban decreases thrombin generation and the development of clots.
Eliquis is available in tablet form, in the following doses: 2.5 mg and 5 mg.
After hip or knee replacement surgery, you have a higher risk of getting a DVT or PE. You’ll start taking Eliquis 12 to 24 hours after your surgery to prevent this. Your healthcare professional will check to make sure the bleeding from your surgery has stopped before you take your first dose of the drug.
The recommended dose of Eliquis is 5 mg orally twice daily. For patients 80 years of age or older, weighing 60 kg or less, or having serum creatinine equal to or above 1.5 mg/dL, the recommended dose is 2.5 mg orally twice daily. Always speak with a healthcare professional about any changes to your dose so they can monitor and evaluate your condition.
Common side effects of Lovenox and Eliquis
The most common side effects of Lovenox in clinical trials include:
- Relevant non-major bleeding – bleeding gums, nose bleeds, and vaginal bleeding
- Swelling (edema) more easily and swelling more
- Pain at the site of injection
- Feeling sick (nausea)
- A discoloration of your skin caused by bleeding or bruising under it (ecchymosis)
- Shortness of breath (dyspnea)
- A low blood platelet count (thrombocytopenia) – may show up in blood tests
- A high level of the enzyme aminotransferase in your blood – may show up in blood tests
More serious side effects of Lovenox include:
- Severe allergic reactions to the medication
- An increased relative risk of major bleeding events, like hemorrhage (bleeding from a ruptured blood vessel)
- Epidural or spinal hematomas (bleeding and accumulation of blood in your spine). These can be caused by medications like Lovenox in patients who receive a spinal puncture or local anesthetic injections around their spine – this could result in paralysis
The most common side effects of Eliquis in clinical trials (incidence ≥1%) compared to placebo include:
- Increased bruising
- Blood in your urine and feces
- Bleeding from your orifices, like your anus or vagina
More serious side effects of Eliquis include
- The potential risk of cardiovascular events such as myocardial infarction or stroke
- Heavy menstrual bleeding
- Black or bloody stools, coughing up blood or vomit that looks like coffee grounds
These aren’t all the side effects Lovenox or Eliquis can cause. You can find more details in the patient leaflet that comes with your medication. If you have any concerns about side effects, talk to your physician or pharmacist.
Lovenox and Eliquis drug interactions
Lovenox can interact with other medications. These include:
- Direct oral anticoagulants – warfarin
- Antiplatelets – aspirin
- Vitamin K antagonists
- Nonsteroidal anti-inflammatory drugs (NSAIDs), like Ibuprofen and naproxen
- Herbal medications that contain garlic, ginger, ginkgo, and ginseng
- Any other medications or supplements that can increase your risk of bleeding
Eliquis can interact with other medications. These include:
- An antifungal medicine
- Antiviral medicines for HIV/AIDS
- Anti-inflammatory medicines
- Pain medications
- Medicines for high blood pressure or heart problems
- Vitamin K antagonists
- Medicines to prevent epilepsy or seizures
- Medicines to treat tuberculosis
- St John’s Wort
Lovenox and Eliquis can interact with other medications. This can change how Lovenox and Eliquis and other medications work and can make side effects more likely. Tell your prescribing physician about all your drugs, including vitamins and dietary supplements.
Lovenox and Eliquis contraindications
You should not use Lovenox if you:
- Are allergic to enoxaparin sodium or any of the other ingredients in Lovenox
- Are allergic to any other heparin, or other low molecular weight heparins such as nadroparin, tinzaparin, or dalteparin
- Are allergic to any pork products
- Are allergic to benzyl alcohol
- Are bleeding heavily, or have a condition with a high risk of bleeding
- Have ever had a reaction called heparin-induced thrombocytopenia which causes a severe drop in your clotting cells (platelets)
- Are under 18 years of age
Talk to your doctor before taking Lovenox if you:
- Are taking any of the medications that could interact with Lovenox (see the section above)
- Have a susceptibility to bleeding (bleeding diathesis)
- Have previously had any bleeding problems
- Have a prosthetic heart valve
- Have uncontrolled high blood pressure (hypertension)
- Have a history of stomach ulcers (gastrointestinal ulceration)
- Have diabetes
- Have had eye damage caused by a complication of diabetes (diabetic retinopathy)
- Have severe kidney problems
- Have severe hepatic (liver) problems
- Are pregnant or are planning to get pregnant
- Are breastfeeding or are planning to breastfeed
- Are over 65 years of age
- Are going to have an operation that involves a lumbar puncture or local anesthetic injections in and around your spine
You should not use Eliquis if you:
- Are allergic to the active ingredient apixaban
- Are allergic to any of the other ingredients found in Eliquis (listed in the leaflet which comes with the medication)
- Have artificial heart valves
- Have antiphospholipid syndrome (APS), especially with positive triple antibody testing, and have a history of blood clots
- Are under 18 years of age
- Are bleeding excessively
- Have an organ condition that increases the likelihood of serious internal bleeding, like a stomach ulcer
Talk to your doctor before using Eliquis if you:
- Have an increased risk of bleeding, such as a bleeding disorder or very high blood pressure
- Are over 75 years of age
- Weigh 60kg or less
- Have severe renal impairment or are on dialysis
- Have a liver problem or a history of liver problems
- Had a catheter or an injection into your spine
- Have antiphospholipid syndrome
- Are lactose intolerant
- Need to have surgery or another procedure that can cause bleeding
- Are pregnant or breastfeeding
Other drugs for the prevention of blood clots
A systematic review and meta-analysis to study for the efficacy and safety of enoxaparin versus new oral anticoagulants to prevent venous thromboembolism after total hip replacement was carried out. The findings of this study revealed no significant difference in the efficacy and safety of new oral anticoagulants compared to enoxaparin for the prevention of venous thromboembolism after total hip replacement surgery. Furthermore, Eliquis has been seen to not meet the primary efficacy outcome of superiority over Lovenox for the endpoint of venous thromboembolism (VTE) and VTE-related death after 30 days.
If you have any concerns about Lovenox or Eliquis side effects, talk to your physician, or pharmacist for medical advice. Also inform your healthcare provider about any medical conditions, supplements, and over-the-counter meds you are taking. You are also encouraged to report side effects to the FDA: visit http://www.fda.gov/medwatch or call 1-800-FDA-1088.