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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. Lovenox is used to temporarily replace your warfarin prior to surgery because it reduces bleeding risks, but still prevents the development of blood clots. This is called Lovenox bridging.

Find as much information as you can about warfarin and Lovenox. Websites and your local pharmacist are good resources. Prepare a list of questions to ask your doctor at your next appointment. Schedule an appointment with your doctor two to three weeks before the date of your procedure.

Bring your list of questions to your doctor's appointment. It will be helpful to bring someone with you who can take notes on the information your doctor provides. Your doctor will discuss the reasons why Lovenox therapy is needed and explain the risks and benefits. You will receive a written instruction sheet that outlines when to stop taking your warfarin and when to begin taking your Lovenox. The doctor will also give you a prescription for Lovenox, which needs to be filled before your first day of therapy. Lovenox comes in prefilled syringes and should be stored at room temperature. Doses are weight-based and vary among patients.

Learn how to self-administer your Lovenox injections. Lovenox is given with a small needle underneath the skin. The normal dosage is two shots per day, given 12 hours apart. The nurse at your doctor's office will teach you how to administer your injections. You will be provided with an instruction sheet and given time to practice the procedure. You will also learn where on your body to insert the needle and how to rotate injection sites. It can be frightening the first time you give yourself an injection. Make sure you are comfortable with the procedure before you leave the doctor's office.

Follow your bridging instructions exactly. Your instructions will usually tell you to stop taking your warfarin four to five days before your surgical procedure. Expect to have blood drawn daily so your doctor can monitor how quickly the warfarin leaves your system. You will also begin giving yourself Lovenox injections one or two days after stopping your warfarin. Hang your doctor's instruction sheet in a visible place for easy access. If you do not follow the instructions exactly, you run the risk of developing a blood clot. If you have any problems following the instructions or have questions, call your doctor.

Notify your doctor immediately if you develop any complications. The most common complication of Lovenox therapy is bleeding. Watch for warning signs such as weakness, confusion, fainting, black stools, bruising or bleeding that is unusual or won't stop.


Avoid activities that increase the risk of bleeding.

Ask your pharmacist for a container to dispose of used needles.

Use caution when shaving or brushing your teeth.


Notify your doctor immediately of any signs of bleeding.

Follow your doctor's instructions carefully.

Ask your doctor before taking any over-the-counter medications.