Lovenox (enoxaparin; Sanofi/Kaken Pharmaceutical) is a subcutaneous low molecular weight heparin approved for the prophylaxis of deep vein thrombosis (DVT) in patients who have undergone abdominal, hip replacement, or knee replacement surgeries, or in medically ill patients with restricted mobility. It is also used in the treatment of DVT in the presence or absence of pulmonary embolism (PE) in patients in a hospital setting, and treating acute DVT without PE in outpatients. Lovenox possesses both factor IIa and factor Xa inhibition activities. It indirectly inhibits platelet aggregation induced by thrombin, thereby decreasing thrombin generation and thrombus development. Factor IIa inhibition is effective by preventing the conversion of fibrinogen into fibrin during the coagulation cascade, thereby inhibiting the development of thrombus.
Lovenox (enoxaparin; Sanofi/Kaken Pharmaceutical) will experience strong competition from the novel oral anticoagulant (NOAC) class of drugs, which have demonstrated superior efficacy and safety. The convenient dosing and improved cost savings associated with the NOAC class will increase their uptake among physicians and payers, which will affect Lovenox’s market share. Lovenox will retain a small portion of the venous thromboembolism (VTE) market as a preferred short-term bridging therapy. Physician familiarity with the drug’s mechanism of action and side-effect profile will continue to drive sales in smaller market segments, such as patients with kidney and liver diseases or in pregnant women.
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