Enoxaparin Use in Pregnancy

Enoxaparin is an anticoagulant. Anticoagulants are medications used to prevent clots from developing in your veins. These medications are also known as blood thinners. Enoxaparin should not be given during pregnancy if there is any type of bleeding. Enoxaparin should not be given in pregnant women with a syndrome characterized by hemolysis (the breakdown of red blood cells), elevated liver enzymes, and low platelet count (HELLP syndrome).

RISKS AND COMPLICATIONS

Using enoxaparin while pregnant can have risks.

  • All pregnant women are at risk for bleeding when on enoxaparin or any other anticoagulant. Some bleeding risks are:

  • Placenta previa.

  • Partial placenta previa.

  • Placental abruption.

  • Bleeding with a threatened abortion or bleeding of unknown cause.

  • Bleeding from the nose or gums that does not stop quickly.

  • Unusual bruising or bruising easily.

  • Swelling or pain at an injection site.

  • A cut that does not stop bleeding within 10 minutes.

  • Continual nausea for more than 1 day or vomiting blood.

  • Coughing up blood.

  • Blood in the urine which may appear as pink, red, or brown urine.

  • Blood in bowel movements which may appear as red, dark or black stools.

  • Sudden weakness or numbness of the face, arm, or leg, especially on one side of the body.

  • Sudden confusion.

  • Trouble speaking (aphasia) or understanding.

  • Sudden trouble seeing in one or both eyes.

  • Sudden trouble walking.

  • Dizziness.

  • Loss of balance or coordination.

  • Severe pain, such as a headache, joint pain, or back pain.

  • Fever.

  • Multiple injection use of enoxaparin vials contain benzyl alcohol as a preservative. This can cross into the placenta. This may result in fatal "Gasping Syndrome" in the newborn baby.

  • If you have received recent epidural anesthesia, spinal anesthesia, or a spinal tap while receiving anticoagulants, you are at risk for developing a blood clot in or around the spine. This condition could result in long-term or permanent paralysis.

  • There is no information available if enoxaparin is excreted in breast milk. Caution should be used when breastfeeding if enoxaparin is to be given.

HOME CARE INSTRUCTIONS

You will be instructed by your caregiver how to give enoxaparin injections.

  1. Before giving your medication you should make sure the injection is a clear and colorless or pale yellow solution. If your medication becomes discolored or has particles in the bottle, do not use and notify your caregiver.

  2. When using the 30 and 40 mg pre-filled syringes, do not expel the air bubble from the syringe before the injection. This makes sure you use all the medication in the syringe.

  3. The injections will be given sub-cutaneously. This means it is given into the fat over the belly (abdomen). It is given deep beneath the skin but not into the muscle. The shots should be injected around the abdominal wall. Change the sites of injection each time. The whole length of the needle should be introduced into a skin fold held between the thumb and forefinger; the skin fold should be held throughout the injection. Do not rub the injection site after completion of the injection. This increases bruising. Enoxaparin injection pre-filled syringes and graduated pre-filled syringes are available with a system that shields the needle after injection.

  4. Inject by pushing the plunger to the bottom of the syringe.

  5. Remove the syringe from the injection site keeping your finger on the plunger rod. Be careful not to stick yourself or others.

  6. After injection and the syringe is empty, set off the safety system by firmly pushing the plunger rod. The protective sleeve will automatically cover the needle and you can hear a click. The click means your needle is safely covered. Do not try replacing the needle shield.

  7. Get rid of the syringe in the nearest sharps container.

  8. Keep your medication safely stored at room temperatures.

  • Due to the complications of anticoagulants, it is very important that you take your anticoagulant as directed by your caregiver. Anticoagulants need to be taken exactly as instructed. Be sure you understand all your anticoagulant instructions.

  • Changes in medicines, supplements, diet, and illness can affect your anticoagulation therapy. Be sure to inform your caregivers of any of these changes.

  • While on anticoagulants, you will need to have blood tests done routinely as directed by your caregivers.

  • Be careful not to cut yourself when using sharp objects.

  • Avoid alcohol use.

  • Limit physical activities or sports that could result in a fall or cause injury.

  • It is extremely important that you tell all of your caregivers and dentist that you are taking an anticoagulant, especially if you are injured or plan to have any type of procedure or operation.

  • Follow up with your laboratory test and caregiver appointments as directed. It is very important to keep your appointments. Not keeping appointments could result in a chronic or permanent injury, pain, or disability.

SEEK MEDICAL CARE IF:

  • You develop any rashes.

  • You have any worsening of the condition for which you are receiving anticoagulation therapy.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Bleeding from the nose or gums does not stop quickly.

  • You have unusual bruising or are bruising easily.

  • Swelling or pain occurs at an injection site.

  • A cut does not stop bleeding within 10 minutes.

  • You have continual nausea for more than 1 day or are vomiting blood.

  • You are coughing up blood.

  • You have blood in the urine.

  • You have dark or black stools.

  • You have sudden weakness or numbness of the face, arm, or leg, especially on one side of the body.

  • You have sudden confusion.

  • You have trouble speaking (aphasia) or understanding.

  • You have sudden trouble seeing in one or both eyes.

  • You have sudden trouble walking.

  • You have dizziness.

  • You have a loss of balance or coordination.

  • You have severe pain, such as a headache, joint pain, or back pain.

  • You have a serious fall or head injury, even if you are not bleeding.

  • You have an oral temperature above 102° F (38.9° C), not controlled by medicine.

ANY OF THESE SYMPTOMS MAY REPRESENT A SERIOUS PROBLEM THAT IS AN EMERGENCY. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in U.S.). Do not drive yourself to the hospital.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.