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Lovenox vs Arixtra
Introduction
For patients prone to blood clotting, certain drugs that alter the formation of clots in the bloodstream can help in preventing thrombotic events and managing symptoms. Lovenox (Enoxaparin) and Arixtra (Fondaparinux) are two such drugs that are administered for this purpose. They each influence different stages of the coagulation cascade but both have anticoagulant effects in patients with a risk of thrombosis. Lovenox is a low molecular weight heparin which inhibits factor Xa and IIa, reducing the ability of clots to form. On the other hand, Arixtra is a synthetic pentasaccharide which selectively binds to antithrombin III leading to selective inhibition of Factor Xa only thus preventing clot formation.
Lovenox vs Arixtra Side By Side
| Attribute | Lovenox | Arixtra |
|---|---|---|
| Brand Name | Lovenox | Arixtra |
| Contraindications | Should not be used with other blood thinners like warfarin or clopidogrel, caution in patients with renal impairment, risk of epidural hematoma with spinal anesthesia or spinal puncture | Should not be used with other blood thinners, caution in patients with renal impairment, no antidote for bleeding complications |
| Cost | Around $430 for 10 pre-filled syringes (40 mg/0.4mL) | Around $560 for 10 pre-filled syringes (2.5mg/0.5mL) |
| Generic Name | Enoxaparin | Fondaparinux |
| Most Serious Side Effect | Unusual bruising or persistent bleeding, severe stomach/abdominal pain, yellowing eyes/skin | Signs of an allergic reaction, unusual bleeding, severe headache, paralysis, slurred speech, sudden vision changes |
| Severe Drug Interactions | Other anticoagulants, drugs affecting renal function | Other anticoagulants, drugs affecting renal function |
| Typical Dose | 30-40 mg/day for prophylaxis, up to 1mg/kg twice daily for acute treatment | 2.5 mg/day administered via subcutaneous injection |
What is Lovenox?
Enoxaparin (the generic name for Lovenox) is a low molecular weight heparin that was first approved by the FDA in 1993. It's primarily used to prevent and treat deep vein thrombosis or pulmonary embolism, and in patients with unstable angina or non-Q wave myocardial infarction. Lovenox thins the blood by inhibiting certain clotting factors, effectively making it more difficult for clots to form within the blood vessels.
Fondaparinux (Arixtra), on the other hand, is a synthetic anticoagulant which was approved by FDA later in 2001; it selectively targets one specific clotting factor (Factor Xa). This selective targeting results in Arixtra having fewer side effects than Enoxaparin as well as less risk of bleeding complications, but also means it might not be suitable for all types of coagulation disorders where broader action might be beneficial.
Both these medications should only be administered under close medical supervision due to their potential serious adverse effects including excessive bleeding and bruising.
What conditions is Lovenox approved to treat?
Lovenox is approved for the treatment of several conditions:
- Prevention of deep vein thrombosis (DVT), which may lead to pulmonary embolism in patients undergoing abdominal surgery, hip or knee replacement surgery, or medical patients with severely restricted mobility during acute illness.
- Treatment of acute ST-segment elevation myocardial infarction (STEMI) managed medically or with subsequent percutaneous coronary intervention (PCI).
- Inpatient treatment of acute DVT with or without pulmonary embolism, when administered in conjunction with warfarin sodium.
- Outpatient treatment of acute DVT without pulmonary embolism, when administered in conjunction with warfarin sodium.
How does Lovenox help with these illnesses?
Lovenox, also known as enoxaparin, helps to manage the risk of blood clots by increasing the amount of antithrombin in the blood. Antithrombin is a natural substance that inhibits clotting factors and prevents them from forming unwanted clots. Lovenox increases this effect by binding to antithrombin III and enhancing its activity against Factor Xa, a key component in blood clot formation. This mechanism plays an important role in preventing deep vein thrombosis (DVT), pulmonary embolism (PE), and other serious conditions associated with excessive clotting.
On the other hand, Arixtra or fondaparinux works similarly but it has a more specific action as it selectively binds only to Factor Xa via antithrombin III without any significant effect on other coagulation factors. Both medications are used for similar purposes but their differences might make one preferable over the other based on individual patient considerations like renal function or history of heparin-induced thrombocytopenia.
What is Arixtra?
Arixtra, also known as fondaparinux, is an anticoagulant medication that prevents the formation of blood clots. It functions as a specific inhibitor for factor Xa in the coagulation pathway, disrupting the process and reducing clotting activity. Fondaparinux was first approved by the FDA in 2001. As Arixtra does not inhibit thrombin (activated Factor II), it has a different action mechanism compared to heparin-based medications like Lovenox (enoxaparin). This particularity means that its side-effect profile is also different than that of drugs like Lovenox; specifically, it causes less platelet reduction and hitsulphatemia but can lead to severe bleeding if not monitored properly. The effects on factor Xa make Arixtra advantageous for preventing deep vein thrombosis and pulmonary embolism following surgery or extended periods of immobility, especially amongst patients who react poorly to typical heparin-based drugs such as Lovenox.
What conditions is Arixtra approved to treat?
Arixtra is approved by the FDA for several critical medical conditions, including:
- Prevention of deep vein thrombosis (DVT), which may lead to pulmonary embolism in patients undergoing hip fracture surgery, hip replacement surgery, or knee replacement surgery.
- Treatment of acute DVT and pulmonary embolism when administered with warfarin sodium.
How does Arixtra help with these illnesses?
Factor Xa is a protein involved in the clotting process, and plays critical roles in many processes within the body, affecting blood coagulation, wound healing, and inflammation. As with other components of the clotting cascade, an overactive Factor Xa can lead to excessive clot formation or thrombosis. Arixtra works by selectively inhibiting Factor Xa in the blood, thereby reducing its ability to initiate clots and alleviating some risks associated with conditions like deep vein thrombosis (DVT) or pulmonary embolism (PE). Its action on this specific point of the clotting cascade may also play roles in making Arixtra a preferred choice for certain patients. Since it does not significantly affect other parts of the coagulation pathway as Lovenox might do, it is sometimes prescribed when a patient has contraindications for heparin-based anticoagulants or does not respond well to them.
How effective are both Lovenox and Arixtra?
Both enoxaparin (Lovenox) and fondaparinux (Arixtra) have established histories of success in preventing and treating thromboembolic disorders like deep vein thrombosis (DVT), pulmonary embolism, and also in the management of unstable angina/non-ST-segment elevation myocardial infarction. They were approved by the FDA within a few years of each other. Since they act on different parts of the coagulation cascade, they may be prescribed under different circumstances.
The effectiveness of enoxaparin and fondaparinux was directly studied in various clinical trials; both drugs exhibited similar efficacy in managing symptoms associated with DVT as well as promising safety profiles. Studies showed that there was no significant difference between patients receiving Lovenox or Arixtra regarding recurrence rates for venous thromboembolism or major bleeding events.
A 2008 review demonstrated that enoxaparin is effective from the first day of administration, has a favorable side effect profile over many other anticoagulants especially concerning heparin-induced thrombocytopenia, and it is well-tolerated even among elderly populations. The same study reports that enoxaparin is one of the most widely used low molecular weight heparins around the world.
On another note, a 2016 meta-analysis indicated that fondaparinux appears to be more effective than placebo at reducing recurrent venous thromboembolism without increasing risk for major bleeding. However, due to its unique pharmacology - being solely an indirect Factor Xa inhibitor - fondaparinux may be considered only after traditional options such as unfractionated heparin or direct oral anticoagulants have been evaluated.
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At what dose is Lovenox typically prescribed?
Injectable dosages of Lovenox range from 30-40 mg/day for prophylaxis, while doses can go up to 1mg/kg twice daily for acute treatment. However, studies have indicated that a prevention dose of 40 mg once daily is sufficient in most cases. Children and adolescents may be started on lower doses based on weight and clinical condition, typically around 0.5mg/kg/dose every 12 hours. The dosage can be increased after a few days if there is no response or as the clinical situation evolves. For Arixtra, the suggested dosage ranges from 2.5–10 mg/day depending on the indication and patient's kidney function; it should not exceed these limits under any circumstances.
At what dose is Arixtra typically prescribed?
Arixtra treatment is generally initiated at a dosage of 2.5 mg/day administered via subcutaneous injection. This does not need to be divided into multiple doses and can be injected all at once. The dose remains consistent and doesn't require an increase over time, making it easier for patient management compared to some other anticoagulants. It's important to note that if there isn't any noticeable response or improvement in the patient’s condition after starting Arixtra, further medical evaluation may be necessary rather than simply increasing the daily dosage.
What are the most common side effects for Lovenox?
Common side effects of Lovenox and Arixtra include:
- Mild irritation, pain, bruising, redness or hardening at the injection site
- Nausea
- Diarrhea
- Fever
- Swelling in your hands or feet.
More severe side effects that require immediate medical attention are unusual bleeding or bruising, signs of a serious allergic reaction (such as difficulty breathing, hives, swelling), tingling/numbness (especially in the lower limbs) and muscle weakness. Always consult with your healthcare professional for any concerns about these medications.
Are there any potential serious side effects for Lovenox?
While Lovenox and Arixtra are both anticoagulant medications used to prevent blood clot formation, each can have different potential side effects. For Lovenox, these may include:
- Signs of bleeding such as unusual bruising or persistent bleeding from small cuts
- Severe stomach/abdominal pain
- Persistent nausea or vomiting
- Dark urine
- Yellowing eyes/skin
Arixtra also shares similar side effects but includes some unique ones like:
- Easy bruising
- Unusual bleeding (nose, mouth, vagina, or rectum)
- Any bleeding that will not stop.
In rare cases, if you experience symptoms of a serious allergic reaction such as rash; itching/swelling (especially of the face/tongue/throat); severe dizziness; trouble breathing while using either drug - immediate medical help is needed.
Keep in mind that this information does not cover all possible side effects. As with any medication decision, it's crucial to discuss these risks and benefits with your healthcare provider before making a choice.
What are the most common side effects for Arixtra?
When using Arixtra, patients may experience some of the following side effects:
- Nausea or vomiting
- Mild irritation or pain at the injection site
- Rash or hives
- Headache and dizziness
- Increased sweating
- Sleep disturbances such as insomnia
- Abdominal pain and constipation
- Feeling anxious, nervousness
- Rapid heartbeat which could be indicative of an allergic reaction.
It's important to note that while these symptoms can occur with Arixtra, they are not typically severe. However, if you do experience any serious side effects like bleeding, confusion or muscle weakness it is crucial to seek immediate medical attention.
Are there any potential serious side effects for Arixtra?
While Arixtra is generally well-tolerated, it can cause serious side effects in some patients. Be sure to seek medical help immediately if you experience any of the following:
- Signs of an allergic reaction such as hives; difficulty breathing or swallowing; swelling of your face, lips, tongue, or throat
- Unusual bleeding (nosebleeds, bleeding gums), severe or continuous headache
- Increased menstrual flow or vaginal bleeding
- Bleeding from wounds or needle injections that doesn't stop easily
- Dark urine and/or yellowing eyes/skin (signs of liver problems)
- Paralysis on one side of the body
- Slurred speech
- Sudden vision changes
Remember that these are not all the possible side effects with Arixtra. Always consult a healthcare professional for advice about side effects.
Contraindications for Lovenox and Arixtra?
Both Lovenox and Arixtra, like most anticoagulant medications, can increase the risk of bleeding. If you notice excessive bruising, prolonged bleeding from cuts or gums, or frequent nosebleeds, please seek immediate medical attention.
Neither Lovenox nor Arixtra should be used if you are taking other blood thinners such as warfarin or clopidogrel. Always inform your healthcare provider about all the medications you are currently on; some drugs may need a significant period to clear out from your system to avoid dangerous interactions with Lovenox and Arixtra.
Patients with renal impairment must exercise caution while using these anticoagulants as they might require dosage adjustment. It's also essential for individuals having spinal anesthesia or undergoing spinal puncture procedures because of the potential risk of epidural hematoma which can cause long-term paralysis.
How much do Lovenox and Arixtra cost?
For the brand name versions of these drugs:
- The price of 10 syringes pre-filled with Lovenox (40 mg/0.4mL) averages around $430, which works out to about $43/day if given once daily.
- The price for a pack of 10 syringes pre-filled with Arixtra (2.5mg/0.5mL) is roughly $560, working out to approximately $56/day.
Thus, if you are on the standard dosage regimen for each drug (i.e., one injection per day), then brand-name Lovenox would be less expensive on a per-day treatment basis compared to Arixtra.
Please note that cost should not be your primary consideration in determining which of these medications is right for you; they have different indications and may not be interchangeable in many situations.
It is essential also to mention that generic versions or biosimilars for both drugs are currently not available due to their complex molecular structure and production process. As such, prices remain relatively high even without considering the additional costs associated with administration and monitoring required by these injectable anticoagulant medications.
Popularity of Lovenox and Arixtra
Enoxaparin, which is also known by the brand name Lovenox, was estimated to have been prescribed to about 2.6 million people in the US in 2020. Enoxaparin accounted for around 20% of anticoagulant prescriptions in the country. This drug belongs to a group called low molecular weight heparins and has been consistently popular since its introduction due to its high efficacy and safety profile.
Fondaparinux, available under the brand name Arixtra, had fewer prescriptions with approximately 500,000 people prescribed this medication in 2020. Fondaparinux accounts for only about 4% of all anticoagulant prescriptions within that year. It's worth noting that fondaparinux is one of several synthetic alternatives to heparin products like enoxaparin and appears less frequently as first-line therapy because it doesn't come with an antidote should bleeding complications arise.
Conclusion
Both Lovenox (enoxaparin) and Arixtra (fondaparinux) have a long-standing record of usage in the prevention and treatment of blood clots, including deep vein thrombosis (DVT) and pulmonary embolism. Both medications are backed by numerous clinical studies indicating their efficacy over placebo treatments. They work through slightly different mechanisms: enoxaparin is a low molecular weight heparin that primarily inhibits factor Xa, while fondaparinux is a synthetic pentasaccharide that selectively binds to antithrombin III.
A physician's careful consideration is required when deciding between these two drugs as they may interact with other medications or contraindicate certain medical conditions. For instance, enoxaparin might be preferred for patients with kidney problems since fondaparinux can accumulate in those individuals due to its longer half-life.
Both drugs come in generic forms representing significant cost savings especially for patients who must pay out of pocket. The effectivity of both Lovenox and Arixtra requires an adjustment period - meaning therapeutic effects may not be noticeable right away.
The side effect profile is similar between the two drugs; common adverse effects include bleeding complications, bruising at injection sites, among others. With both drugs, it's important for patients to monitor any signs of excessive bleeding or allergic reactions closely after each dose administration.
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Refrences
- Melo, F., & Mourão, P. (2008). An algal sulfated galactan has an unusual dual effect on venous thrombosis due to activation of factor XII and inhibition of the coagulation proteases. Thrombosis and Haemostasis. Georg Thieme Verlag KG.http://doi.org/10.1160/th07-10-0649
- Bauer, K. A. (2004, March). Fondaparinux: a new synthetic and selective inhibitor of Factor Xa. Best Practice & Research Clinical Haematology. Elsevier BV.http://doi.org/10.1016/j.beha.2004.03.004
- Carter, N. J., McCormack, P. L., & Plosker, G. L. (2008). Enoxaparin. Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/00003495-200868050-00012
- Ramakrishna, P., Gupta, P. C., Pai, P., Rai, K., Rajkumar, M., Sahu, T., … Subramaniyan, A. (2021, August 25). Effectiveness and Tolerability of Fondaparinux vs Enoxaparin in a Population of Indian Patients with Symptomatic Deep Vein Thrombosis: A Retrospective Real-World Study. Drugs - Real World Outcomes. Springer Science and Business Media LLC.http://doi.org/10.1007/s40801-021-00273-4
- Galla, J. M., & Mahaffey, K. W. (2005, June). Clinical use of enoxaparin in the management of non-ST segment elevation acute coronary syndromes. Expert Opinion on Pharmacotherapy. Informa Healthcare.http://doi.org/10.1517/14656566.6.7.1241
- Turpie, A. G. (2004, June). Fondaparinux: a Factor Xa inhibitor for antithrombotic therapy. Expert Opinion on Pharmacotherapy. Informa Healthcare.http://doi.org/10.1517/14656566.5.6.1373