Lovenox vs. Coumadin for Heart Attack and Deep Vein Thrombosis: Important Differences and Potential Risks.

Key takeaways

Enoxaparin (Lovenox) and warfarin (Coumadin, Jantoven) are both anticoagulants, or blood thinners, used to prevent and treat blood clots. They are similar in that they help manage conditions like deep vein thrombosis (DVT) and pulmonary embolism (PE). However, they differ in several ways. Enoxaparin is a low-molecular-weight heparin given as an injection, while warfarin is a vitamin K antagonist taken orally. Enoxaparin is often used for short-term treatment, especially in hospital settings, and is often preferred during pregnancy. Warfarin, on the other hand, is not safe during pregnancy and requires regular blood tests to monitor its effects. Enoxaparin does not require routine blood monitoring, but it can cause injection site reactions and is not ideal for those with kidney problems. Warfarin interacts with many foods and medications, requiring careful dietary management. Both medications can cause serious bleeding, and both have possible anidotes available for emergencies.

Enoxaparin

(Lovenox)

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Warfarin

(Coumadin)

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Summary for Lovenox

Prescription only

Enoxaparin (Lovenox) is a blood thinner that's used to treat and prevent blood clots and other clotting-related conditions. It's given as an injection under the skin in the stomach. The dosing for enoxaparin (Lovenox) depends mostly on your weight, but also on why you need the medication. Enoxaparin (Lovenox) is a preferred choice for pregnant women, but it might not be the best option if they have prosthetic (artificial) heart valves. Side effects aren't common, but can include bleeding or bruising at the injection site. Enoxaparin (Lovenox) is available as a brand and generic medication.

Indications for Lovenox

Prevention of blood clots in the arms or legs (deep vein thrombosis or DVT) or in the lungs (pulmonary embolism or PE) in:
- People having stomach, hip, or knee surgery
- People who aren't able to move well
- People with a certain type of chest pain called unstable angina
Treatment of blood clots
Heart attack

Pros and Cons for Lovenox

Pros

Works well to treat several types of blood-clotting problems
Safe to use during pregnancy (except those with prosthetic heart valves)
Possible medication available that might help work as an antidote (reversal agent) to reverse effects
Blood tests are available to check how well the medication is working, but they're not required

Cons

Only available as an injection, which can be uncomfortable
Might be difficult for some people to inject at home
Might not be a good option for people with kidney problems
Can cause a serious low platelet condition called heparin-induced thrombocytopenia (HIT)

Common Side Effects for Lovenox

Abnormal liver tests (6%)
Major bleeding (up to 4%)

Warnings for Lovenox

Risk of bleeding around the spinal cord during other injections near the spine
Risk of bleeding
Low platelet counts and clotting problems
Higher risk of clots in pregnant women with prosthetic heart valves
Risk of serious breathing problem in infants (gasping syndrome)

Summary for Coumadin

Prescription only

Warfarin (Coumadin) is a blood thinner (anticoagulant). It's used to prevent and treat blood clots in adults and children with conditions such as deep vein thrombosis (DVT) or pulmonary embolism (PE). Warfarin (Coumadin) is taken by mouth, typically once daily. Your provider will adjust the dose based on your international normalized ratio (INR). Taking too much warfarin (Coumadin) can lead to side effects like bruising and serious bleeding. If needed, your provider can give you an antidote to reverse the effects of warfarin (Coumadin).

Indications for Coumadin

Prevention and treatment blood clots in the veins
Prevention and treatment blood clots linked to atrial fibrillation (AFib) or heart valve replacement
Prevention of more blood clots and to lower risk of death after a heart attack

Pros and Cons for Coumadin

Pros

Each strength of tablet is a unique color, making it easy to tell them apart
Only needs to be taken once a day
Has an antidote available in case of an emergency
Available as a lower-cost generic

Cons

Only prevents new blood clots from forming or getting bigger; it doesn't work on existing blood clots
Requires regular blood draws to check INR levels
Interacts with foods and many commonly-prescribed medications
Not safe to take during pregnancy