Lovenox is a branded medication used for the prevention of venous thromboembolism (VTE), a condition that includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Heparin is a generic (non-branded) injection used to prevent blood clots from forming in patients with certain medical conditions.
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 (LMWH) with antithrombotic properties. However, it is not the same as standard heparin. Lovenox is used for anticoagulation and thromboprophylaxis. It can help treat or stop blood clots forming in blood vessels. It is 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
- Acute Coronary Syndrome
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 block the cut and 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 Heparin?
Heparin (heparin sodium) is an FDA (U.S. Food and Drug Administration) approved medication manufactured by various generic manufacturers. Heparin also known as standard heparin or unfractionated heparin (UFH), is a generic injection. It is an anticoagulant that prevents blood clots from forming. Heparin is also used as a prophylactic, before surgery to reduce the risk of blood clots. Unfractionated heparin may be used for anticoagulation in hospitalized patients with conditions requiring the temporary discontinuation of warfarin. Conditions include:
- Chronic atrial fibrillation
- Cardiomyopathy/Left ventricular aneurysm
- Prosthetic heart valves
- Prior deep vein thrombosis or pulmonary embolism
- Prior arterial embolic events
Heparin injection is not recommended to flush out an intravenous (IV) catheter. Using the incorrect heparin to flush a catheter can result in fatal bleeding.
Heparin is available in a range of strengths. Your doctor will decide the appropriate dose for you based on your medical condition. Heparin is injected under the skin or as an infusion into a vein. Injections should be prepared only when ready to use.
You will need regular tests to measure your blood-clotting time. These tests will help your doctor decide whether it is safe for you to continue using this medicine. Tell the healthcare provider that you are using heparin if you need surgery, dental work, or a medical procedure.
You may be changed from injectable heparin to an oral blood thinner. You may need to use the injection and the oral form for a short time. Continue using the injection until your doctor tells you to stop.
Common side effects of Lovenox and Heparin
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 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 medical patients who receive a spinal puncture or local anesthetic injections around their spine – this could result in paralysis
The most common side effects of Heparin in clinical trials include:
- Allergic reactions
- Unusual or uncontrolled bleeding
- Unusual bruising
- Abnormal liver function tests
More serious side effects of Heparin include
- Heparin-induced thrombocytopenia (severe reaction to heparin, in which the heparin reacts with antibodies in the blood, causing platelets to decrease. Heparin has a higher risk of HIT than Lovenox)
- Nausea, vomiting
- Loss of appetite
- Skin changes at the injection site
- Sudden numbness or weakness
- Problems with vision or speech
- Swelling or redness in an arm or leg
- Chest pain, irregular heartbeats
- Shortness of breath, dizziness, anxiety, sweating
- Severe pain or swelling in your stomach, lower back, or groin
- Dark or blue-colored skin on your hands or feet
- Unusual tiredness
- Nosebleeds, blood in your urine or stools, black or tarry stools, or coughing up blood or vomit that looks like coffee grounds
These aren’t all the side effects Lovenox or Heparin 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 Heparin 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
- Platelet inhibitors
- Herbal medications that contain garlic, ginger, ginkgo, and ginseng
- Any other medications or supplements that can increase your risk of bleeding
Heparin can interact with other medications. These include:
- Direct oral anticoagulants – warfarin
Lovenox and Heparin can interact with other medications. This can change how Lovenox and Heparin 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 Heparin 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 impairment or renal failure
- 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 Heparin if you:
- Are allergic to the active ingredient heparin or pork products
- Have a history of low platelets in your blood caused by heparin or pentosan polysulfate
- Have a severe lack of platelets in your blood
- Have uncontrolled bleeding
Talk to your doctor before using Heparin if you:
- Are taking any of the medications that could interact with Heparin
- Have an infection of the lining of your heart
- Have severe or uncontrolled high blood pressure
- Have a bleeding or blood clotting disorder
- Have a stomach or intestinal disorder
- Have liver disease
- Are menstruating
- Are pregnant or plan to become pregnant
- Are breastfeeding or are planning to breastfeed
If you have any concerns about Lovenox or Heparin 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.