Instructions for use of Clexane. Clexane injections for thrombosis of various etiologies and natures
It is rare that a pregnant woman manages to avoid health problems during such a crucial period. To maintain a normal state, you often have to take various medications. One of the products that you have to use during pregnancy is Clexane. It is prescribed if antiplatelet therapy is necessary and only under the strict supervision of a specialist.
Description of the medicine
To treat and prevent the formation of blood clots, the drug Clexane, which belongs to the group of anticoagulants, is used. The medication is used in traumatology, surgery, and orthopedics. The active component of the drug - enoxaparin sodium - has an antithrombotic effect, thins the blood and is a derivative. During pregnancy, Clexane is prescribed with caution and in small doses, which does not affect the duration of bleeding.
The drug is a liquid (colorless or pale yellow) for injection, which is released in special syringes. Various dosages of the active ingredient are available: 2000, 4000, 6000, 8000 and 10,000 anti-Xa ME in one syringe. The package contains two doses of the drug.
Indications for use
Injections with the drug are prescribed for the treatment of the following pathological conditions:
- Deep vein thrombosis.
- Venous embolism after surgery.
- Prevention of the formation of blood clots and embolism in people who are in a supine position for a long time.
- Patients on hemodialysis to prevent the formation of clots (if the procedure lasts no more than 4 hours).
- Angina and myocardial infarction.
Use of Clexane during pregnancy
According to the manufacturer's official instructions, an anticoagulant can be used during pregnancy only as a last resort, if the benefit to the mother outweighs the risk of complications for the fetus. In fact, the practice of prescribing the drug for pregnant women exists, and it is quite successful. Despite this, specialists are obliged to warn patients about the insufficient number of studies regarding the effect of the active substance on fetal development.
Most doctors prescribe Clexane injections during pregnancy only from the 2nd trimester. For prevention purposes, the medicine is used at a later date. Without the advice of a specialist, you should not use an anticoagulant to thin the blood to avoid serious consequences.
The main purpose of the medicine during pregnancy is to prevent thrombosis of deep veins located in the pelvis, groin and legs. Due to the peculiarity of their position, it is these veins that suffer most often.
Are there any contraindications?
Among the main contraindications to the use of the drug are the threat of bleeding associated with termination of pregnancy, hemorrhagic stroke of the brain, aneurysm, and gastrointestinal ulcer during an exacerbation. The following pathologies and factors also include contraindications:
- Intolerance to the components of the drug.
- History of ischemic cerebral stroke.
- Arterial hypertension.
- Age up to 18 years.
- Diabetes.
- Recent birth.
- Various pathologies associated with impaired hemostasis.
- Open wounds.
- Active tuberculosis.
- Severe respiratory diseases.
- Pericarditis.
- The presence of malignant tumors in the body.
- Excess weight.
- Kidney (liver) failure.
- Availability of intrauterine contraception.
How to calculate the dosage?
It is difficult to independently determine the required amount of medication for treatment or prevention. The dosage is calculated only by the doctor, individually for each case. For pregnant women, the daily dose can be 20-40 mg. The duration of therapy depends on the severity of the patient's condition. Typically, noticeable improvements appear within 7-10 days. Sometimes therapy is extended to 14 days.
If it is necessary to prevent the formation of blood clots before surgery, it is recommended to administer 20 or 40 mg of the drug to the patient once (depending on the condition). The first injection is given 2 hours before surgery. When treating a heart attack, the dosage of the drug is calculated based on the patient's weight.
Clexane during pregnancy: how to inject?
The drug is produced only in the form of a solution for subcutaneous administration. Therefore, in the absence of experience, the first injections should be carried out in a medical facility. According to the instructions, the injection must be given in the side of the abdomen. To obtain a positive result of therapy, you should adhere to the rules for administering the drug "Clexane" during pregnancy. Reviews from women confirm the effectiveness of the medicine if all recommendations are followed.
First of all, you need to prepare the injection site. The woman should take a lying position, grasp the fold of skin on the side of the abdomen and insert the needle completely (strictly vertically). You can open the fold only after the drug has been completely introduced.
Many pregnant women are afraid of such manipulation, but in fact there should be no reason to worry. Clinics must instruct the expectant mother and show her how to select the correct injection site and give the injection. After manipulation, the injection site must not be rubbed or massaged.
Side effects
The anticoagulant during pregnancy "Clexane" is used exclusively according to indications and under the supervision of the attending physician, because the drug significantly increases the risk of bleeding. At the slightest suspicion of the development of such a pathological condition, you should immediately stop treatment with the drug and contact a medical facility.
In some cases, the development of thrombocytopenia was recorded in the first days of anticoagulant treatment. Most often, pain occurs at the injection sites, hematomas, compactions, and swelling form. An allergic reaction sometimes manifests itself in the form of a skin rash and redness. If any negative reaction of the body to the administration of enoxaparin sodium occurs, you should consult a specialist.
Pregnancy is a very important time in the life of every woman. It would seem that nature has calculated all the nuances and features of the functioning of organs during the period of waiting for a baby, but in some cases a well-functioning system can fail. It is at these moments that it is important to quickly determine the diagnosis and help the body cope with the problem. Pharmacology offers a large selection of medications, including Clexane. Why can a doctor recommend its use?
Clexane is a drug that has an antithrombotic effect. The therapeutic effect during the treatment process is achieved thanks to the active substance - enoxaparin sodium. The medicine arrives on the shelves of pharmacy chains in disposable syringes, which contain liquid for injection. The doctor selects only the dosage. Manufacturers produce Clexane in 1.0 ml, 0.8 ml, 0.6 ml, 0.4 ml or 0.2 ml of a clear or yellowish solution.
It is worth noting that syringes are intended for single use only. They should not be used to administer other medications or Clexane repeatedly. After the procedure, the system must be disposed of.
Clexane is produced in the form of syringes that cannot be reused
Entering the body through subcutaneous administration, the active substance reaches full concentration in the blood after three to a maximum of five hours. Enoxaparin sodium is excreted also by the kidneys.
While expecting a baby, women are prohibited from starting treatment with Clexane on their own. This is due to the fact that a sufficient number of studies have not been conducted, so doctors cannot say with certainty whether the active component penetrates the placental barrier. However, doctors, based on clinical observations of pregnant women who used the drug, do not note its negative impact on the development and health of the fetus.
Indications for use of Clexane during pregnancy
From the moment of conception, significant changes occur in the pregnant woman's body. First of all, this concerns blood formation. Many women know that blood volume increases, because it should be enough for the growing fetus. But not everyone knows about the increase in its coagulability: this is a kind of insurance for a woman in labor, preventing bleeding during childbirth. Nature has carefully provided for everything. However, these factors increase the load on the circulatory system, which in some cases leads to dilation of the walls of blood vessels, the onset of the inflammatory process, and subsequently to the development of thrombus formation.
Fatigue, swelling of the legs, pain - all these are the first signs of varicose veins, which can provoke the formation of blood clots in the vessels
During pregnancy, women must undergo tests. If, based on the results of the study, the expectant mother is diagnosed with hypercoagulation (a strong increase in blood clotting), she is prescribed medications that help dilute the vital fluid and prevent the formation of blood clots.
Blood clots are dangerous not only for the health of the mother. They can also form in the vessels of the placenta, which leads to impaired blood circulation between the body of the woman and the fetus: blood flow slows down or stops altogether. Because of this, the child lacks oxygen and nutrients. This situation is extremely dangerous, since it negatively affects the development of the baby, and can also cause its intrauterine death.
Doctors prescribe treatment for the expectant mother with Clexane injections in the following cases:
- prevention and treatment of blood clots (including to prevent the formation of blood clots in women who have been on bed rest for a long time);
- thrombosis after surgery;
- angina pectoris - acute chest pain that occurs due to insufficient blood supply to the heart;
- heart attack is a pathological condition due to circulatory disorders.
When can a doctor prescribe Clexane?
The decision about the possibility of including Clexane in the treatment regimen is made only by the doctor. In the first three months of pregnancy, doctors try not to prescribe injections to expectant mothers. This is due to the fact that there is no data on the effect of the active substance on the embryo. In the early stages, it is extremely important to minimize the risks of developing pathologies in the baby, because it is during this period that all the organs and systems of the child are formed.
According to the instructions, the drug is not recommended for use by pregnant women. However, in practice, doctors often prescribe it starting in the second trimester. But the treatment is carried out under the supervision of a doctor who carefully monitors the mother’s health and studies changes in blood counts.
The growing uterus not only puts pressure on a woman’s internal organs, but also increases pressure on the veins. As a result, inflammation of the vessel walls and the formation of blood clots occurs. Clexane is intended to prevent blood clots in the pelvic area and lower extremities.
How to give injections
The method of administration of Clexane is different from the usual one. The fact is that the drug is prohibited to be injected intramuscularly or intravenously. According to the instructions, the injection is given deep under the skin in the left and right areas of the abdomen in turn. The dosage is determined only by the doctor, depending on the diagnosis of the expectant mother and the individual characteristics of the pregnancy. Most often, women expecting a baby are prescribed a daily dose of 0.2–0.4 ml of solution.
Instructions for insertion under the skin on the abdomen
To properly introduce the drug into the body, you must adhere to the following recommendations.
For convenience, doctors advise performing the procedure in a lying position. The course of treatment is also determined by the attending physician. On average it is 7–14 days.
How to properly discontinue the drug: quit abruptly or gradually
Cancellation of Clexane before childbirth has its own characteristics. In some situations, the injection is stopped abruptly (for example, when there is a threat of miscarriage and bleeding). But in most cases, this must be done gradually and under the supervision of a doctor, slowly reducing the dosage and conducting regular blood tests. Before a planned cesarean section, the use of the drug is usually stopped a day before the operation, and then several more injections are given to prevent the formation of blood clots.
A specialist will tell you about all the intricacies of Clexane withdrawal.
Contraindications and side effects, as well as possible consequences for the child
Clexane is a serious medicine that has a fairly extensive list of contraindications. It is prohibited to inject the solution into a woman’s body if she has one or more conditions:
- allergic reactions to the components of the drug, which is a manifestation of individual intolerance to the active substances;
- risk of bleeding: threat of miscarriage, hemorrhagic stroke (rupture of a cerebral vessel followed by hemorrhage), aneurysm (protrusion of the artery wall due to its thinning or stretching);
- hemophilia is a hereditary disease characterized by a violation of the blood clotting process;
- the presence of an artificial valve in the heart.
In addition to these contraindications, there are a number of diseases for which Clexane must be used with great caution:
- stomach ulcer or erosive lesions of the mucous membrane;
- severe forms of diabetes mellitus;
- impaired kidney or liver function;
- large open wounds (to avoid the development of serious bleeding).
Treatment with Clexane is carried out under the supervision of a doctor to assess the condition of the woman and fetus
During or after administration, the solution may cause unpleasant symptoms. Women should know that if they occur, they should not take another injection. You should consult your doctor to change the drug or adjust the dose of the drug. The expectant mother may experience the following side effects:
- headaches, dizziness;
- allergic reactions: irritation, rash, itching;
- with long-term use of Clexane, liver cirrhosis may develop;
- hematomas at the site of injection of the solution.
Concomitant use with other drugs
It is forbidden to use Clexane together with other drugs that affect blood clotting processes, for example, with Curantil or Dipyridamole. Clexane is not used with certain groups of medications, for example, non-steroidal anti-inflammatory drugs, anticoagulants (prevent blood clotting) and thrombolytics (dissolve blood clots), so as not to provoke bleeding.
What analogues and other options for replacing Clexane are there?
There are other medications based on enoxaparin sodium on the pharmacological market, so pharmacists can offer a replacement. Complete analogues of Xexan are:
If, as a result of treatment with Clexane, a woman experiences unpleasant symptoms or has contraindications to its use, the attending physician will select another drug. The following have similar therapeutic effects:
- Fraxiparine - the active substance is effective for the treatment and prevention of blood clots;
- Warfarin - comes in the form of blue tablets and is used while expecting a child only in the second and third trimesters;
- Fragmin - solution for injection has an antithrombotic effect.
Gallery: Fraxiparin, Warfarin, Hemapaxan and other drugs used to treat blood clots
Fragmin is prescribed to pregnant women to treat thrombosis 
Warfarin should not be used in the first trimester of pregnancy Fraxiparine is available as an injection solution 
Anfiber is available in several dosages. Hemapaxan is used to thin the blood and combat blood clots.
Table: characteristics of drugs that can be prescribed to pregnant women to replace Clexane
| Name | Release form | Active substance | Contraindications | Use during pregnancy |
| solution in ampoules | dalteparin sodium |
|
The drug can be used during pregnancy, the risk of complications for the fetus is minimal. However, it persists, so the medicine should be injected only on the recommendation of a doctor. | |
| pills | warfarin sodium |
|
The substance quickly crosses the placenta and causes birth defects between 6 and 12 weeks of pregnancy. During pregnancy and childbirth, it can cause bleeding. Warfarin is not prescribed in the first trimester, or in the last 4 weeks before the baby is born. At other times, use only when absolutely necessary. |
|
| injection solution in syringes | nadroparin calcium |
|
Experiments on animals have not shown a negative effect of nadroparin calcium on the fetus; however, in the first 12 weeks of pregnancy, it is preferable to avoid prescribing Fraxiparine, both in a prophylactic dose and in the form of a course of treatment. During the II and III trimesters, it can be used only in accordance with the doctor’s recommendations for the prevention of venous thrombosis (when comparing the benefits to the mother with the risk to the fetus). Course treatment is not used during this period. |
Clexane - refers to direct-acting anticoagulants, heparin and its derivatives, used in the treatment and prevention of thrombosis.
Release form and composition of Clexane
Clexane is available in the form of a clear, colorless or yellowish solution intended for subcutaneous administration. The drug is sold in syringes with a capacity of 0.2, 0.4, 0.6, 0.8 or 1 ml, which respectively contain 20, 40, 60, 80 and 100 mg of the active substance - enoxaparin sodium and water for injection (in as a solvent). Syringes, in the amount of two pieces, are placed in blisters, which are placed in 1 or 5 units in cardboard packs.
pharmachologic effect
Clexane exhibits antithrombotic properties and is used for subcutaneous injections in the treatment of acute coronary syndrome, deep vein thrombosis, as well as their prevention. Enoxaparin sodium, the active ingredient of Clexane, is obtained by alkaline hydrolysis of heparin (in the form of benzyl ether), produced from the mucous membrane of the small intestine of pigs. Enoxaparin sodium belongs to the group of low molecular weight heparins, exhibiting high anti-Xa activity; this substance has a slight negative effect on thrombin.
Indications for use
As indicated in the instructions attached to Clexan, the medication is indicated for use for the prevention of venous thrombosis and embolism:
- During hemodialysis;
- In persons forced to remain on long-term bed rest due to acute conditions provoked by severe infections, acute respiratory and heart failure, rheumatic processes in the acute phase (with risk factors for thrombosis), severe forms of CHF, etc.;
- During surgical intervention, especially after orthopedic and general surgical operations.
Clexane is also used for the treatment of deep vein thrombosis (including combination with pulmonary embolism), unstable angina (with complex therapy), myocardial infarction without a Q wave.
Contraindications
According to the instructions for Clexane, its use is not recommended for:
- Hypersensitivity to heparin and its derivatives;
- Under 18 years of age (due to the lack of data on the safety of use in children);
- Conditions and pathologies with a high risk of bleeding: aortic or cerebral aneurysm, hemorrhagic stroke, threatened abortion, uncontrollable bleeding.
- Severe damage to the kidneys and liver;
- Gastric ulcer;
- Recent childbirth;
- Arterial hypertension, in severe form;
- Hemorrhagic or diabetic retinopathy;
- Bacterial endocarditis;
- Complicated diabetes mellitus;
- Pericarditis;
- Active tuberculosis;
- Severe vasculitis;
- Injuries and open wounds with a large surface area;
- Intrauterine contraception;
- Hemostasis disorders.
Clexane is also used with caution after recent neurological or ophthalmological operations, radiation therapy, spinal puncture, or when combined with medications that affect hemostasis.
Directions for use and dosage
According to the instructions, Clexane is administered only subcutaneously; intramuscular injections of the drug are prohibited. The medication is administered deeply subcutaneously in a lying position, alternately into the right and left zones of the abdominal wall. When using Clexane 0.4 and 0.2 ml, air bubbles are not removed from the syringe before injection to avoid loss of the medicine. The syringe needle must be inserted to its full length into the skin fold, vertically, and not from the side. The fold must be held during the injection and released only after the injection is completed; it is not recommended to massage the injection site.
To prevent thrombosis and embolism in acute therapeutic diseases, patients on bed rest are prescribed Clexane 0.4 ml once a day. According to reviews of Clexane, therapy can last an average of 1-2 weeks and be extended if necessary. Before surgery for operations in general surgery, the drug, for prophylactic purposes, is prescribed in a dosage of 20 ml and administered 2 hours before they are performed once a day. If a patient is diagnosed with a high risk of thrombus formation and embolism, Clexane 0.4 ml is administered once 12 hours before surgery. The course of treatment is usually 7-10 days, but is sometimes extended according to the doctor’s decision. After orthopedic operations, the duration of therapy with Clexane 0.4 can reach 5 weeks when administered once a day. When carrying out hemodialysis, the medication is prescribed for prophylactic purposes in a dosage of 1 mg per 1 kg of body weight.
Use during pregnancy and lactation
Due to the lack of reliable information about taking Clexane during pregnancy and lactation, its use during these periods is not recommended. Administration of the drug for prophylactic purposes is possible only in exceptional cases for strict medical reasons. If you need to use Clexane during lactation, you must stop breastfeeding.
Side effects
According to reviews of Clexane from patients, the most common use of the drug can lead to: thrombocytopenia (manifests at the beginning of therapy and is temporary), skin rash, pain and hematomas at the injection site. Bleeding may occur, which requires discontinuation of Clexane until the cause is determined. Much less often, during treatment with medication, the appearance of allergic reactions, including those of a systemic nature (the development of vasculitis), can also be observed.
In this article you can read the instructions for use of the drug Clexane. Reviews of site visitors - consumers of this medicine, as well as the opinions of specialist doctors on the use of Clexane in their practice are presented. We kindly ask you to actively add your reviews about the drug: whether the medicine helped or did not help get rid of the disease, what complications and side effects were observed, perhaps not stated by the manufacturer in the annotation. Clexane analogues in the presence of existing structural analogues. Use for the treatment and prevention of thrombosis and embolism in adults, children, as well as during pregnancy and lactation.
Clexane- low molecular weight heparin preparation (molecular weight about 4500 daltons: less than 2000 daltons - approximately 20%, from 2000 to 8000 daltons - approximately 68%, more than 8000 daltons - approximately 18%). Enoxaparin sodium (the active ingredient of the drug Clexan) is obtained by alkaline hydrolysis of heparin benzyl ester isolated from the mucous membrane of the small intestine of pigs. Its structure is characterized by a non-reducing 2-O-sulfo-4-enpyrazinosuronic acid moiety and a reducing 2-N,6-O-disulfo-D-glucopyranoside moiety. The structure of enoxaparin contains about 20% (ranging from 15% to 25%) 1,6-anhydro derivative in the reducing portion of the polysaccharide chain.
In the purified system, Clexane has high anti-10a activity (approximately 100 IU/ml) and low anti-2a or antithrombin activity (approximately 28 IU/ml). This anticoagulant activity acts through antithrombin 3 (AT-3) to provide anticoagulant activity in humans. In addition to anti-10a/2a activity, additional anticoagulant and anti-inflammatory properties of enoxaparin sodium have also been identified in both healthy humans and patients, and in animal models. This includes AT-3-dependent inhibition of other coagulation factors such as factor 7a, activation of tissue factor pathway inhibitor (TFP) release, and decreased release of von Willebrand factor from the vascular endothelium into the circulation. These factors provide the anticoagulant effect of enoxaparin sodium in general.
When the drug is used in prophylactic doses, it slightly changes the aPTT, has virtually no effect on platelet aggregation and the level of fibrinogen binding to platelet receptors.
Anti-2a activity in plasma is approximately 10 times lower than anti-10a activity. The average maximum anti-2a activity is observed approximately 3-4 hours after subcutaneous administration and reaches 0.13 IU/ml and 0.19 IU/ml after repeated administration of 1 mg/kg body weight when administered twice and 1.5 mg/kg body weight when administered once, respectively. .
The average maximum anti-10a plasma activity is observed 3-5 hours after subcutaneous administration of the drug and is approximately 0.2, 0.4, 1.0 and 1.3 anti-10a IU/ml after subcutaneous administration of 20, 40 mg and 1 mg/kg and 1.5 mg/kg respectively.
Compound
Enoxaparin sodium + excipients.
Pharmacokinetics
The pharmacokinetics of enoxaparin in the indicated dosage regimens is linear. The bioavailability of enoxaparin sodium when administered subcutaneously, assessed on the basis of anti-10a activity, is close to 100%. Enoxaparin sodium is mainly biotransformed in the liver by desulfation and/or depolymerization to form low molecular weight substances with very low biological activity. The elimination of the drug is monophasic. 40% of the administered dose is excreted by the kidneys, with 10% unchanged.
There may be a delay in the elimination of enoxaparin sodium in elderly patients due to decreased renal function.
In patients with impaired renal function, a decrease in the clearance of enoxaparin sodium is observed.
In patients with excess body weight, the clearance of the drug is slightly less when administered subcutaneously.
Indications
- prevention of venous thrombosis and embolism during surgical interventions, especially orthopedic and general surgical operations;
- prevention of venous thrombosis and thromboembolism in patients on bed rest due to acute therapeutic diseases (acute heart failure, chronic heart failure in the decompensation stage of functional class 3 or 4 according to the NYHA classification, acute respiratory failure, severe acute infection, acute rheumatic diseases in combination with one of the risk factors for venous thrombosis);
- treatment of deep vein thrombosis with or without pulmonary embolism;
- prevention of thrombus formation in the extracorporeal circulatory system during hemodialysis (usually with a session duration of no more than 4 hours);
- treatment of unstable angina and myocardial infarction without a Q wave in combination with acetylsalicylic acid;
- Treatment of acute ST-segment elevation myocardial infarction in patients undergoing medical treatment or subsequent percutaneous coronary intervention.
Release forms
Solution for injection 0.2 ml, 0.4 ml, 0.6 ml, 0.8 ml and 1 ml (injections in syringe ampoules).
There is no dosage form in tablet form.
Instructions for use, dosage and method of use (how to inject the drug correctly)
With the exception of special cases (treatment of myocardial infarction with ST-segment elevation, medication or using percutaneous coronary intervention and prevention of thrombus formation in the extracorporeal circulatory system during hemodialysis), enoxaparin sodium is administered deeply s.c. It is advisable to carry out injections with the patient lying down. When using pre-filled 20 mg and 40 mg syringes, do not remove air bubbles from the syringe before injection to avoid loss of the drug. Injections should be performed alternately into the left or right anterolateral or posterolateral surface of the abdomen. The needle must be inserted vertically (not from the side) into the skin fold for its entire length, collected and held until the injection is completed between the thumb and forefinger. The skin fold is released only after the injection is completed. Do not massage the injection site after administering the drug.
The pre-filled disposable syringe is ready for use.
The drug cannot be administered intramuscularly!
Prevention of venous thrombosis and embolism during surgical interventions, especially during orthopedic and general surgical operations
For patients with a moderate risk of developing thrombosis and embolism (general surgery), the recommended dose of Clexane is 20 mg once a day subcutaneously. The first injection is given 2 hours before surgery.
For patients with a high risk of developing thrombosis and embolism (general surgical operations and orthopedic operations), the drug is recommended at a dose of 40 mg 1 time per day s.c., the first dose is administered 12 hours before surgery, or 30 mg 2 times a day s.c. the beginning of administration 12-24 hours after surgery.
The average duration of treatment with Clexane is 7-10 days. If necessary, therapy can be continued as long as the risk of thrombosis and embolism remains (for example, in orthopedics, Clexane is prescribed at a dose of 40 mg once a day for 5 weeks).
Prevention of venous thrombosis and embolism in patients on bed rest due to acute therapeutic diseases
Treatment of deep vein thrombosis with or without pulmonary embolism
The drug is administered subcutaneously at a dose of 1.5 mg/kg body weight 1 time per day or at a dose of 1 mg/kg body weight 2 times a day. In patients with complicated thromboembolic disorders, the drug is recommended to be used at a dose of 1 mg/kg 2 times a day.
The average duration of treatment is 10 days. It is advisable to immediately begin therapy with indirect anticoagulants, while Clexane therapy must be continued until a sufficient anticoagulant effect is achieved, i.e. MHO should be 2-3.
Prevention of thrombus formation in the extracorporeal circulation system during hemodialysis
The dose of Clexane is on average 1 mg/kg body weight. If there is a high risk of bleeding, the dose should be reduced to 0.5 mg/kg body weight with double vascular access or 0.75 mg with single vascular access.
During hemodialysis, the drug should be injected into the arterial site of the shunt at the beginning of the hemodialysis session. One dose is usually sufficient for a 4-hour session, however, if fibrin rings are detected during longer hemodialysis, you can additionally administer the drug at the rate of 0.5-1 mg/kg body weight.
Treatment of unstable angina and non-Q wave myocardial infarction
Clexane is administered at a rate of 1 mg/kg body weight every 12 hours subcutaneously, while simultaneously administering acetylsalicylic acid at a dose of 100-325 mg once a day. The average duration of therapy is 2-8 days (until the patient’s clinical condition stabilizes).
Treatment of ST-segment elevation myocardial infarction, medical or percutaneous coronary intervention
Treatment begins with an intravenous bolus of enoxaparin sodium at a dose of 30 mg and immediately after it (within 15 minutes) subcutaneous administration of Clexane at a dose of 1 mg/kg is carried out (and during the first two subcutaneous injections, a maximum of 100 mg of enoxaparin can be administered sodium). Then all subsequent subcutaneous doses should be administered every 12 hours at a rate of 1 mg/kg body weight (i.e., for body weight more than 100 kg, the dose may exceed 100 mg).
In persons 75 years of age and older, the initial intravenous bolus is not used. Clexane is administered subcutaneously at a dose of 0.75 mg/kg every 12 hours (moreover, during the first two subcutaneous injections, a maximum of 75 mg of enoxaparin sodium can be administered). Then all subsequent subcutaneous doses should be administered every 12 hours at the rate of 0.75 mg/kg body weight (i.e., for body weight more than 100 kg, the dose may exceed 75 mg).
When combined with thrombolytics (fibrin-specific and fibrin-nonspecific), enoxaparin sodium should be administered in the interval from 15 minutes before the start of thrombolytic therapy to 30 minutes after it. As soon as possible after detection of acute ST-segment elevation myocardial infarction, acetylsalicylic acid should be started simultaneously and, unless contraindicated, should be continued for at least 30 days at doses of 75 to 325 mg daily.
Bolus administration of enoxaparin sodium should be administered through a venous catheter and enoxaparin sodium should not be mixed or administered with other drugs. In order to avoid the presence of traces of other drugs in the system and their interaction with enoxaparin sodium, the venous catheter should be flushed with a sufficient amount of 0.9% sodium chloride or dextrose solution before and after an intravenous bolus of enoxaparin sodium. Enoxaparin sodium can be safely administered with 0.9% sodium chloride solution and 5% dextrose solution.
To carry out a bolus administration of enoxaparin sodium at a dose of 30 mg in the treatment of acute myocardial infarction with ST-segment elevation, the excess amount of the drug is removed from glass syringes of 60 mg, 80 mg and 100 mg so that only 30 mg (0.3 ml) remains in them. A dose of 30 mg can be administered directly IV.
For intravenous bolus administration of enoxaparin sodium through a venous catheter, pre-filled syringes for subcutaneous administration of the drug 60 mg, 80 mg and 100 mg can be used. It is recommended to use 60 mg syringes, because... this reduces the amount of drug removed from the syringe. 20 mg syringes are not used, because they do not contain enough drug for a bolus of 30 mg enoxaparin sodium. 40 mg syringes are not used, because there are no divisions on them and therefore it is impossible to accurately measure the amount of 30 mg.
In patients undergoing percutaneous coronary intervention, if the last subcutaneous injection of enoxaparin sodium was performed less than 8 hours before inflating the balloon catheter inserted into the site of narrowing of the coronary artery, additional administration of enoxaparin sodium is not required. If the last subcutaneous injection of enoxaparin sodium was carried out more than 8 hours before inflation of the balloon catheter, an additional intravenous bolus of enoxaparin sodium should be administered at a dose of 0.3 mg/kg.
To improve the accuracy of additional bolus administration of small volumes into the venous catheter during percutaneous coronary interventions, it is recommended to dilute the drug to a concentration of 3 mg/ml. It is recommended to dilute the solution immediately before use.
To obtain a 3 mg/ml enoxaparin sodium solution using a 60 mg prefilled syringe, it is recommended to use a 50 ml infusion solution container (i.e., 0.9% sodium chloride solution or 5% dextrose solution). 30 ml of solution is removed and removed from the container with the infusion solution using a regular syringe. Enoxaparin sodium (the contents of the syringe for subcutaneous administration is 60 mg) is injected into the remaining 20 ml of infusion solution in the container. The contents of the container with the diluted solution of enoxaparin sodium are carefully mixed.
Side effect
- bleeding;
- retroperitoneal bleeding;
- intracranial bleeding;
- neuraxial hematomas;
- thrombocytopenia (including autoimmune thrombocytopenia);
- thrombocytosis;
- increased activity of liver transaminases;
- allergic reactions;
- hives;
- redness of the skin;
- hematoma and pain at the injection site;
- skin (bullous) rashes;
- inflammatory reaction at the injection site;
- skin necrosis at the injection site;
- anaphylactic and anaphylactoid reactions;
- hyperkalemia.
Contraindications
- conditions and diseases in which there is a high risk of bleeding (threatened abortion, cerebral aneurysm or dissecting aortic aneurysm (except for surgical intervention), hemorrhagic stroke, uncontrolled bleeding, severe enoxaparin- or heparin-induced thrombocytopenia);
- age under 18 years (efficacy and safety have not been established);
- hypersensitivity to enoxaparin, heparin and its derivatives, including other low molecular weight heparins.
Use during pregnancy and breastfeeding
Clexane should not be used during pregnancy unless the expected benefit to the mother outweighs the potential risk to the fetus. There is no information that enoxaparin sodium crosses the placental barrier in the 2nd trimester; there is no information regarding the 1st and 3rd trimesters of pregnancy.
When using Clexane during lactation, breastfeeding should be stopped.
Use in elderly patients
In persons 75 years of age and older, the initial intravenous bolus is not used. Enoxaparin sodium is administered subcutaneously at a dose of 0.75 mg/kg every 12 hours (moreover, during the first two subcutaneous injections, a maximum of 75 mg of enoxaparin sodium can be administered). Then all subsequent subcutaneous doses are administered every 12 hours at the rate of 0.75 mg/kg body weight (i.e., for body weight more than 100 kg, the dose may exceed 75 mg).
Use in children
Contraindicated in children and adolescents under 18 years of age (efficacy and safety have not been established).
special instructions
When prescribing the drug for prophylactic purposes, there was no tendency to increase bleeding. When prescribing the drug for therapeutic purposes, there is a risk of bleeding in older patients (especially those over 80 years of age). Close monitoring of the patient's condition is recommended.
It is recommended that the use of drugs that can disrupt hemostasis (salicylates, acetylsalicylic acid, non-steroidal anti-inflammatory drugs (NSAIDs), including ketorolac; dextran with a molecular weight of 40 kDa, ticlopidine, clopidogrel; glucocorticosteroids (GCS), thrombolytics, anticoagulants, antiplatelet agents, including glycoprotein antagonists 2b/3a receptors) was discontinued before starting treatment with enoxaparin sodium, unless their use was strictly indicated. If combinations of enoxaparin sodium with these drugs are indicated, careful clinical observation and monitoring of relevant laboratory parameters should be carried out.
In patients with impaired renal function, there is a risk of bleeding as a result of increased anti-10a activity of enoxaparin sodium. In patients with severe renal impairment (CK< 30 мл/мин) рекомендуется проводить коррекцию дозы как при профилактическом, так и терапевтическом назначении препарата. Хотя не требуется проводить коррекцию дозы у пациентов с легким и умеренным нарушением функции почек (КК 30-50 мл/мин или КК 50-80 мл/мин), рекомендуется проведение тщательного контроля состояния таких пациентов.
An increase in the anti-10a activity of enoxaparin sodium when administered prophylactically in women weighing less than 45 kg and in men weighing less than 57 kg may lead to an increased risk of bleeding.
The risk of autoimmune thrombocytopenia caused by heparin also exists with the use of low molecular weight heparins. If thrombocytopenia develops, it is usually detected between 5 and 21 days after initiation of enoxaparin sodium therapy. In this regard, it is recommended to regularly monitor the platelet count before starting treatment with the drug and during its use. If there is a confirmed significant decrease in platelet count (by 30-50% compared to the initial value), it is necessary to immediately discontinue enoxaparin sodium and transfer the patient to another therapy.
Spinal/epidural anesthesia
As with the use of other anticoagulants, cases of neuraxial hematomas have been described when using the drug Clexane against the background of spinal/epidural anesthesia with the development of persistent or irreversible paralysis. The risk of these events is reduced when using the drug at a dose of 40 mg or lower. The risk increases with increasing dosage of the drug, as well as with the use of penetrating epidural catheters after surgery, or with the concomitant use of additional drugs that have the same effect on hemostasis as NSAIDs. The risk also increases with trauma or repeated lumbar puncture, or in patients with a history of spinal surgery or spinal deformity.
To reduce the risk of bleeding from the spinal canal during epidural or spinal anesthesia, it is necessary to take into account the pharmacokinetic profile of the drug. It is best to install or remove a catheter when the anticoagulant effect of enoxaparin sodium is low.
Installation or removal of the catheter should be carried out 10-12 hours after using the drug Clexane in prophylactic doses to prevent deep vein thrombosis. In cases where patients receive higher doses of enoxaparin sodium (1 mg/kg 2 times a day or 1.5 mg/kg 1 time a day), these procedures should be postponed for a longer period of time (24 hours). Subsequent administration of the drug should be carried out no earlier than 2 hours after removal of the catheter.
If the physician prescribes anticoagulant therapy during epidural/spinal anesthesia, the patient should be closely monitored for any neurological signs and symptoms, such as: back pain, sensory and motor disturbances (numbness or weakness in the lower extremities), bowel and/or bladder functions. The patient should be instructed to immediately inform the doctor if the above symptoms occur. If signs or symptoms consistent with a spinal cord hematoma are detected, prompt diagnosis and treatment are required, including spinal decompression if necessary.
Heparin-induced thrombocytopenia
Clexane should be prescribed with extreme caution to patients with a history of heparin-induced thrombocytopenia, with or without thrombosis.
The risk of thrombocytopenia caused by heparin may persist for several years. If heparin-induced thrombocytopenia is suspected based on the history, platelet aggregation tests are of limited value in predicting the risk of its development. The decision to prescribe Clexane in this case can only be made after consultation with an appropriate specialist.
Percutaneous coronary angioplasty
In order to reduce the risk of bleeding associated with invasive vascular manipulation in the treatment of unstable angina and non-Q wave myocardial infarction, the catheter should not be removed for 6-8 hours after subcutaneous administration of Clexane. The next calculated dose should be administered no earlier than 6-8 hours after removal of the femoral artery introducer. It is necessary to monitor the site of invasion in order to promptly identify signs of bleeding and hematoma formation.
Artificial heart valves
No studies have been conducted to reliably assess the effectiveness and safety of Clexane in preventing thromboembolic complications in patients with artificial heart valves. The use of the drug for this purpose is not recommended.
Laboratory tests
At doses used for the prevention of thromboembolic complications, Clexane does not significantly affect bleeding time and blood coagulation parameters, as well as platelet aggregation or their binding to fibrinogen.
As the dose increases, the aPTT and clotting time may prolong. The increase in aPTT and clotting time are not in direct linear relationship with the increase in the antithrombotic activity of the drug, so there is no need to monitor them.
Prevention of venous thrombosis and embolism in patients with acute therapeutic diseases who are on bed rest
In the case of the development of acute infection, acute rheumatic conditions, prophylactic administration of enoxaparin sodium is justified only if the above conditions are combined with one of the listed risk factors for venous thrombus formation: age over 75 years, malignant neoplasms, history of thrombosis and embolism, obesity, hormonal therapy, heart failure , chronic respiratory failure.
Impact on the ability to drive vehicles and operate machinery
Clexane does not affect the ability to drive vehicles and machines.
Drug interactions
Clexane cannot be mixed with other drugs!
You should not alternate the use of enoxaparin sodium and other low molecular weight heparins, because They differ from each other in production method, molecular weight, specific anti-10a activity, units of measurement and dosage. And, as a consequence of this, the drugs have different pharmacokinetics and biological activity (anti-2a activity, interaction with platelets).
With systemic salicylates, acetylsalicylic acid, nonsteroidal anti-inflammatory drugs (NSAIDs) (including ketorolac), dextran with a molecular weight of 40 kDa, ticlopidine and clopidogrel, systemic glucocorticosteroids (GCS), thrombolytics or anticoagulants, other antiplatelet drugs (including glycoprotein 2b/3a antagonists ) the risk of bleeding increases.
Analogs of the drug Clexane
Structural analogues of the active substance:
- Anfiber;
- Hemapaxan;
- Enoxaparin sodium.
Analogs by pharmacological group (anticoagulants):
- Angiox;
- Angioflux;
- Antithrombin 3 human;
- Arixtra;
- Warfarex;
- Warfarin;
- Venabos;
- Venolife;
- Viatromb;
- Hemapaxan;
- Gepalpan;
- Heparin;
- Heparin ointment;
- Heparoid;
- Hepatrombin;
- Dolobene;
- Ellon gel;
- Calciparin;
- Klivarin;
- Xarelto;
- Lavenum;
- Lyoton 1000;
- Marewan;
- Nigepan;
- Pelentan;
- Piyawit;
- Pradaxa;
- Seprotin;
- Sinkumar;
- Skinlight;
- Troxevasin Neo;
- Trombless;
- Thrombogel;
- Thrombophobe;
- Troparin;
- Phenilin;
- Fragmin;
- Fraxiparine;
- Fraxiparine Forte;
- Cibor;
- Exanta;
- Eliquis;
- Emeran;
- Enoxaparin sodium;
- Essaven.
If there are no analogues of the drug for the active substance, you can follow the links below to the diseases for which the corresponding drug helps, and look at the available analogues for the therapeutic effect.
To prevent thrombosis, vascular accidents and other cardiovascular problems, Clexane injections are prescribed. The drug belongs to the group of low molecular weight heparins, has multiple contraindications, and should be used only under the supervision of a physician.
Composition and release form
Clexane is produced in the form of injection solutions: a completely clear to pale yellow liquid in glass syringes. One cardboard package contains from 1 to 5 blisters of 2 syringes each. The official international name of Clexane is Enoxaparin, the Latin name is clexane.
The solution contains water for injection as an auxiliary component. The active ingredient is low molecular weight sodium enoxaparin. The dosage of 1 syringe is measured in international units of anti-CA ME and is:
| Syringe volume | Dose of anti-CA ME |
Properties of the drug components
The drug belongs to the group of low molecular weight anticoagulants of the heparin class. Clexane has high anti-Xa activity and a relatively low ability to inhibit thrombin. The mechanism of pharmacological action of the drug is the activation of the protein antithrombin, which slows down the activity of factor X, without having a significant effect on platelet synthesis.
Under the influence of enoxaparin, APTT (activated partial thromboplastin time - the period during which a blood clot forms after calcium chloride or other reagents are added to it) may slightly change. The bioavailability of the active component when administered subcutaneously is 100%. Enoxaparin is completely metabolized by the liver and 40% is excreted by the kidneys. The half-life is 4 hours (with single use) and 7 hours (with repeated administration).
Why is Clexane prescribed?
The drug is used for the treatment and prevention of cardiovascular diseases. According to the instructions, the main indications for prescribing injections are:
- prevention of venous embolism or thrombosis after surgery;
- treatment of deep vein thrombosis uncomplicated by pulmonary embolism;
- prevention of thrombosis in patients who are forced to remain in bed for a long time - heart failure, severe infections, respiratory failure, rheumatic diseases;
- treatment of angina pectoris;
- therapy for myocardial infarction without Q waves;
- treatment of acute infarction in individuals with ST segment enlargement.
How to inject Clexane
Instructions for use of the drug indicate that the solution must be injected deeply subcutaneously into the left or right side of the abdomen when the patient is in a supine position. After the injection, it is not recommended to massage or rub the injection site. The dosage regimen and frequency of injection depend on the diagnosis:
| Dosage | Frequency of administration | Duration of treatment |
|
| Treatment of deep vein thrombosis | 1.5 mg per 1 kg of patient’s body weight | 1 time/day | |
| Prevention of thrombosis, embolism | 1 time/day | ||
| Patients at average risk of blood clots | 1 time/day | ||
| Patients at high risk of blood clots | 1-2 times/day |
special instructions
Clexane is prohibited from being administered intramuscularly to pregnant and lactating women and children. In addition, the instructions contain the following instructions regarding treatment:
- If you experience a feeling of numbness or tingling in the extremities, impaired tactile sensations, intestinal upset or bladder dysfunction, you should stop using Clexane and consult a doctor immediately.
- The drug does not have a significant effect on human psychomotor abilities. Driving a car or taking part in work with increased concentration is possible throughout the course of therapy.
- If the dosages and frequency of use specified in the instructions are followed, the drug does not affect platelet synthesis and hematopoiesis time.
- During therapy, it is necessary to regularly take blood tests to monitor and detect possible bleeding in time.
- Starting from days 15 to 21 of therapy, the patient's chance of developing thrombocytopenia (a condition characterized by a decrease in the number of platelets) increases. If treatment was prescribed for more than 10 days, it is necessary to monitor blood counts and compare them with the initial laboratory test data.
- Patients with liver, kidney problems, and elderly people should consult a doctor to adjust the treatment regimen.
Drug interactions
The instructions for use of Clexan warn that the drug is strictly prohibited from combining or alternating with other low molecular weight heparins. During treatment, it is important to consider the following abilities of the injection solution to interact with other medications:
- The therapeutic effect of enoxaparin increases when combined with acetylsalicylic acid, warfarin derivatives, clopidogrel, dipyridamole, and the fibrinolytics ticlopidine.
- Plasma substitutes, gout medications, loop diuretics and penicillins increase the effectiveness of Clexane.
- The simultaneous use of low molecular weight heparins and nonsteroidal anti-inflammatory drugs (NSAIDs) increases the risk of hemorrhage (bleeding).
- Antihistamines, cardiac glycosides, smoking, tetracycline antibiotics reduce the effectiveness of Clexane.
- Concomitant use of low molecular weight heparins and anticonvulsants, antiarrhythmic medications or beta blockers leads to a decrease in the effectiveness of the latter.
Clexane and alcohol
The simultaneous use of the solution with alcohol or alcohol-containing drinks is strictly prohibited. Ignoring this instruction may result in increased side effects, liver failure, and hemorrhagic apoplexy (sudden paralysis caused by ruptured arteries and bleeding in the brain).
Side effects
Clexane increases the risk of bleeding, especially when taking other drugs that affect hemostasis simultaneously. If blood flow disturbances are detected, you must immediately stop taking the medication. Other side effects of Clexane include:
| Organ or system | ||
| Headache. |
||
| Hematopoiesis | Hematoma, nosebleeds, thrombocytopenia. | Intracranial hemorrhages, retroperitoneal hemorrhages. |
| Immune | Allergy (erythema, itching). | Anaphylactic shock. |
| Liver and bile ducts | Increased activity of transaminases (liver enzymes). | Cholestatic liver damage. |
| Musculoskeletal | Osteoporosis (when taking the drug for longer than 3 months). |
|
| Skin and soft subcutaneous tissues | Inflammation, swelling at the injection site, hardening of soft tissues. | Skin necrosis. |
Overdose
Cases of drug overdose are extremely rare. Clinically, this manifests itself in increased side effects and an increased risk of bleeding. In case of overdose, the patient is advised to slowly administer a neutralizing substance - protamine sulfate. One milligram of this drug completely suppresses the effect of 1 mg of enoxaparin. Administration of protamine sulfate is not required if more than 12 hours have passed since the onset of the overdose.
Contraindications
Clexane is used only according to the instructions and under the supervision of a doctor. The medicine has a number of categorical contraindications that should be taken into account before starting treatment. These include:
- individual intolerance to Clexane;
- conditions accompanied by an increased risk of bleeding - abortion, threatened miscarriage, aortic aneurysm, hemorrhagic stroke;
- children's age (up to 18 years);
- presence of artificial heart valves in the patient’s body.
Injections should be administered with caution to elderly patients and people with liver or kidney diseases. Other relative contraindications include:
- pathologies that are accompanied by impaired hemostasis - hemophilia, severe vasculitis, thrombocytopenia, hypocoagulation;
- erosive and ulcerative lesions of the gastrointestinal tract;
- recent ischemic stroke;
- complicated diabetes mellitus;
- recent childbirth, ophthalmological or neurological surgery;
- performing spinal and epidural anesthesia;
- performing a spinal tap;
- use of intrauterine contraception;
- pericarditis;
- bacterial endocarditis;
- severe arterial hypertension (high blood pressure).
Terms of sale and storage
The drug is released strictly according to prescription. Clexane should be stored according to the instructions at temperatures up to 25 °C. Shelf life – 3 years.
Analogs
If Clexane is not available in the pharmacy, the doctor may prescribe other medications with an identical principle of action. Analogs with the same active component are:
- Clexane 300 – available in 3 ml bottles. It has completely similar indications and contraindications as Clexane. Available only by prescription.
- Novoparin – solution for injection. Available in glass syringes of 1 or 2 pcs. on the packaging with instructions. Used for the prevention and treatment of thrombosis.
- Enoxarin - low molecular weight heparin is available in dispensing syringes of 2, 4, 8 thousand anti-Xa ME. Prescribed for the treatment of deep vein thrombosis.
Fraxiparine or Clexane - which is better?
In case of individual intolerance to enoxaparin sodium, medications with similar pharmacological properties, but with a different active ingredient, are prescribed. An analogue of Clexan based on calcium nadroparin is Fraxiparine. The drug has the same list of indications, contraindications, and side effects. Detailed comparative studies have not been conducted between Clexane and Fraxiparine, so the choice of the preferred drug should be made by a doctor.
Clexane price
The cost of the injection solution may vary depending on the pricing of the pharmacy, the dosage of Clexane, and the number of disposable syringes in the package. Average prices in Moscow:
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