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Lovenox Bridging, Instructions. 02 Apr / admin / Diseases, Conditions, Treatments; ,Lovenox, and warfarin are two common blood-thinning medications that prevent blood clots. If you take warfarin and require surgery, you have an increased risk of bleeding.
Specific agents as possible APT-,bridging, strategies • Unfractionated heparin and low molecular weight heparins – patients not on oral anticoagulant: –– The use of unfractionated heparin and low molecular weight heparins for ,bridging, purposes is discouraged due to the lack of evidence supporting the efficacy and safety of this strategy.
Bridging, is continued, typically for 4 to 6 days, until the anticoagulant effect of warfarin has resumed and the blood is sufficiently thinned again. What Dose Should Be Used for ,Bridging,? A therapeutic-dose regimen, for example, ,enoxaparin, (,Lovenox,) 1 mg/kg twice daily, is often used
Bridge, therapy; Low: All patients: Last dose of warfarin on day -6 pre procedure; Hold warfarin day -5 through day -1; Consider vitamin K 2.5mg PO on day -1 pre-procedure if INR > 1.5; Resume warfarin 12-24 hours post-procedure at 1 to 1.5 times usual maintenance dose (decision based on post-op assessment of bleeding risk) High or Moderate: CrCl>50
• The MD orders ,enoxaparin, 1mg/kg BID to start tomorrow AM, and warfarin to re-start this evening. What do you do? – Verify the ,enoxaparin, order of 1mg/kg BID – Call the MD to suggest ,bridging, with UFH instead of ,enoxaparin,. – Call the MD to suggest not ,bridging, in this patient
This calculator does not advise on the details of timing and dose of ,bridging, therapy and you should refer to the appropriate oral anticoagulation guidelines. Patients commenced on warfarin therapy need treatment overlap for 5 days and until INR >2 for at least 24 hours, which ever is the longer 6 .
• ,Lovenox, 1 mg/kg (maximum dose 150 mg) every 12h (venous thromboembolism) (outpatient or inpatient Rx). ... • Unfractionated heparin may be used as ,bridging, anticoagulation in hospitalized patients with chronic conditions requiring temporary discontinuation of warfarin.