Medication: Lovenox Blood Thinner For Avascular Necrosis / AVN Treatment

Medication: Lovenox Blood Thinner For Avascular Necrosis / AVN Treatment



Looking through the infinite pages of the internet, I found very few medication treatments for Avascular Necrosis (AVN). Most doctors, if they recommend treatment, throw pain killers, nerve suppressors or surgical options your way.

My first lovenox shot!
My first lovenox shot!

I was lucky to find a doctor who wanted to help me get to the bottom of why I had AVN. So many orthopedics told me it was idiopathic and it’s hard to know for certain why I had it. I don’t blame the orthos. They have so much on their plate, and are pressured by the healthcare industry to see so many patients a day, how could they possibly know everything about everything?! My beef with their answers is that bones don’t just die for no reason. There HAS to be a reason. And it’s fine if you don’t know or don’t want to help me find out – tell me that. Tell me the truth. Don’t tell me that there’s really no way I’ll ever know why it happened.

For me, my AVN was caused by a mutation on my prothrombin gene which is a factor 2 blood clotting disorder. The doctor that I was seeing said that if my bone had not started to collapse that there was a 98% chance he could help me. Since it started to collapse no one could be sure if the blood thinners would be successful or not. To me, it was worth trying. Why wouldn’t I at this point? This doctor knew so much about avascular necrosis and I felt optimistic about his protocols.

His avn treatment protocol was to take 100mg of lovenox a day, split up into two different injections (40mg in the morning and 60mg at night), for 3 months. After the 3 months I’d get an MRI and X-ray to see how the drug reacted to my AVN. My doctor cautioned me that we most likely wouldn’t see any results in 3 months, but every 3 months I’d get an MRI and X-ray to see how things are doing.

First off.

If your doctor tells you that you’re going to need to do these injections – DO NOT do what I did. I went and google image and twitter searched ‘lovenox’. Yes, there is a lot of great information about the drug out there, but there are some things that you probably don’t want to see before you start taking it as well. I watched videos of people taking their injections and SCREAMING that it burned so bad. There are also tons of pictures of people who bruised quite badly from the injections as well.

I guess I should preface the following statement by saying these two things:

1. I have a pretty high threshold for pain (After having Complex Regional Pain Syndrome (CRPS) I’m pretty sure I won’t even wince while having a baby)

2. I’ve been doing humira injections for over a year. For about 10-15 seconds it burns like hell.

Ok… so the statement…

I really don’t think lovenox shots are something to spend a second thought on.

The first few times I did the injections they did burn and I did feel them. But after about a week I didn’t feel the injections and as time went on I realized tips and tricks to make it easier.

So learn from my avn treatment experience. Here are my thoughts on how to make it painless!


~ Rotate your injection sites. I learned from my humira shots which I rotate Left Leg, Right Leg, Right Side of Abdomen, Left Side of Abdomen. Now it’s harder to keep track since you’re doing 2 injections a day with the lovenox. So I’d do leg days and tummy days.


Monday Morning- Left Leg

Monday Night- Right Leg

Tuesday Morning- Left Side of my tummy

Tuesday Night- Right Side of my tummy

Honest moment… I felt that injecting in my tummy was relatively painless, whereas the legs were more sensitive. And not even so much upon actually injecting the medication, but afterwards. I always seemed to have marks and swollen areas left on my legs, but not as much on my stomach.

~ Wipe with alcohol swab and wait for the area to be completely dry before trying to inject. This is a little tip I picked up from a nurse that I know. She said that a lot of times it stings because you’re pushing the alcohol into your skin. If you wait until it’s dry then you won’t have this problem.

~ Make sure to inject on an angle. Don’t do it straight in. I always pinched about an inch of ‘love’ and then would inject the shot at a 45 degree angle. (I can’t take credit for this one, the nurse who showed me how to do the injections told me this one – Even though the Lovenox injections say to do it on a 90 degree angle)

~ Don’t create more pain than you need to for yourself. What I mean by that is, take that needle and pierce it through your skin quickly- don’t do it slowly. You may think if you do it slowly then you’ll ‘ease’ into it – but this is wrong. You’ll prolong it and make it more painful. The more quickly you pierce through your skin the less painful the injection will be!

Honest moment… easy to say in theory, but I know there were times when I’d psych myself out (even though I didn’t think the shots hurt) and would do it slowly. Be gentle with yourself and just do the best you can! Every shot won’t be painless, but over time you can work to make it as painless as possible!

~ Inject the medicine slowly. I found the more rapidly I pushed the plunger down the more burn I received. Sometimes I would be doing the injections, get caught up with something on tv or in a convo and next thing I knew I pushed that baby in so fast you couldn’t even count to 3. Just do yourself a favor and try to do it in a 5-10 count. I’ve been told that if you do it quickly that you’re more likely to bruise. Technically, a bruise is blood in the skin. If you inject the medication too quickly then you’ll have that high concentration of blood thinner in that one spot, allow blood to more easily slip out into your skin and cause a bruise. Note: I’m not saying that if you do the injection slowly you’ll never get a bruise. I still bruised a bit, but nothing like I see others have online. I truly think it just depends on the individual. Some are more prone to bruising than others.

~ Be kind to, and have patience, with yourself. No one ever says ‘Oh! I’m totally so excited to start injecting myself twice a day!’ I won’t lie – the first few times I did them I was completely and totally freakeddddd out. Even til the end there were some days were I would freak myself out. I don’t think anyone ever is completely ok with injecting themselves, but if the benefits outweigh the negatives then it must be worth it – right? Just think how amazing it would be to walk without those crutches, cane or braces. Maybe these teeny, tiny needles can help bring you pain free days! Wouldn’t THAT be something!


I was extremely lucky to not receive much bruising and had no side effects at all. Per my doctor’s orders, I went to get a CBC Diff blood test drawn every 3 weeks. After the first 3 weeks of lovenox injections you’ll be completing those blood tests with ease!

Also- when you order your injections make sure you ask for a sharps container. If you do not get one you can use an empty milk or orange juice carton. I’ve done both and as long as you’re properly disposing of the injections then you’re good!

IMG_8437I can HAPPILY tell you that my first 3 months of this avn treatment went so well that I’m continuing with the lovenox injections for another 3 months. My doctor usually switches patients to an oral anti-coagulant, but since I started seeing such positive results I opted for a more aggressive approach. I’m not entirely excited to be receiving my boxes on boxes of syringes in the mail again- but honestly, for the first time since my avascular necrosis diagnosis I feel like I’m on the right path.

A lot of times I see patients using lovenox injections while they’re pregnant aside from the avn treatment. I know this will be me one day since I’ve been diagnosed with Factor 2 Clotting (a mutation on my prothrombin gene). These small injections would totally be worth a cute little baby. <3

What has your experience with lovenox been like? Was your similar or different than mine? Share your stories in the comments below!

Wishing You A Pain Free Day!



  • Derek

    I started enoxaparin injections 120mg (split into 2x daily 60mg), and completed for about 3 weeks. They gave me really bad nausea, lost my appetite & was forcing myself to eat and bathroom problems.

    I didn’t find giving the injections to be so bad, I just made sure to move around the injection site really well. I did right side of abdomen in the morning and tried to use the same location on the left side of my abdomen for evening. I got a couple of small dot shaped bruises and had a couple that stung a bit but overall most were painless as long as I slowly eased the plunger down.

    I’m hoping to be able to switch to an alternative anticoagulant to be able to complete my first 3 months.