Clexane injections for thrombosis of various etiologies and nature. Clexane during pregnancy, indications and consequences

Today we will talk about the drug Clexane. Many have heard about it, but few know whether you really need it and in what cases is it prescribed?

Clexane is a drug that provides you with an antithrombotic effect. During pregnancy, hormonal levels change greatly, and with it the most common problems of pregnant women are anemia (when they start prescribing you iron, etc., which corrects your hemoglobin) and increased blood clotting, which increases every month. In fact, this is a common concern of nature, which thus prevents pregnant women from severe blood loss during childbirth.

But if a pregnant woman is predisposed to thrombosis, this can be dangerous for both mother and baby (hypoxia, miscarriage). Therefore, after carrying out the appropriate tests, I can prescribe Clexane to the pregnant woman. The main active ingredient of the drug is enoxaparin sodium - a substance that, when it enters the blood, reaches a concentration after a couple of hours and thins the blood.

Clexane is available only in injection form, sold as a disposable syringe. The volume of the syringe may be different, and you will need the dose that the doctor prescribes for you: 0.2 ml, 0.4 ml, 0.6 ml, 0.8 ml. or 1 ml. The injection may be clear or yellowish, but don't let that bother you.

The contents of the syringe are injected immediately and the syringe itself is then thrown away; using it to inject other liquids is strictly prohibited.

Why is it prescribed to pregnant women: indications for use

The list of mandatory tests for an expectant mother may not always include a check for blood clots, which are very dangerous. This test is carried out in the form of a coagulogram - a study of blood clotting. But if your obstetrician-gynecologist notices some symptoms, you will definitely be recommended to do this test.

Symptoms in pregnant women usually include:

  • constant swelling of the legs;
  • pain in the calves or in the hollow behind the knees;
  • pain in the lower leg or thigh;
  • hemorrhoids with severe pain.

And according to reviews from pregnant women, why they were prescribed Clexane, these were precisely these symptoms. Therefore, be sure to inform your doctor about all unusual conditions in your body, this is very important: the sooner the treatment is adjusted, the better and easier your birth will be.

If the doctor discovers that the blood values ​​are different from the norm, he must intervene. As a rule, those drugs that dissolve blood clots and thin the blood. Blood clots are not good because they can be located anywhere, including in the placental vessels, which will disrupt the flow of nutrients from mother to child and can lead to hypoxia and even miscarriage.

Clexane is prescribed only by a specialist after a comprehensive analysis of all factors. Clexane is most often not prescribed from the 1st trimester, but from the second it is mandatory if we are talking about:

  • treatment of blood clots;
  • with thrombosis after surgery;
  • with heart attack and angina pectoris.

Clexane injections into the stomach during pregnancy are prescribed only after special tests and are carried out under the careful and regular supervision of a gynecologist and with constant monitoring of blood counts. Using Clexane on your own is strictly prohibited, especially during pregnancy. Only a competent specialist can regulate this process, correct it and stop it if it is possible to try to do without drugs, which, of course, is always better for the unborn baby.

Clexane: contraindications and side effects

Clexane is a very serious drug that should not be joked with, so if you have been prescribed it, do not be alarmed, there is nothing wrong with it, except for the need to correct your condition and preparation for childbirth, but be sure to listen carefully and write down all the doctor’s instructions.

Clexane has quite a few contraindications:

  • risk of early birth;
  • hemorrhagic stroke;
  • tuberculosis in the active phase;
  • hypertension;
  • presence of a cardiac prosthesis;
  • age under 18 years;
  • heavy weight;
  • neoplasms;
  • disorders of the liver or kidneys;
  • diabetes;
  • open wounds;
  • stomach ulcer.

There are also serious nuances when stopping the drug. The dose of Clexane should be reduced gradually. But if there is a threat of miscarriage, its use is stopped immediately. In any case, again, this is all the competence of the doctor.

Side effects of Clexane

  • Allergic reaction;
  • swelling at the injection site;
  • skin problems at the injection site;
  • headache;
  • neurological problems;
  • hematomas (due to incorrect injection technique);
  • hyperkalemia.

If the drug is abused on its own, much more severe problems can occur, such as liver cirrhosis, hemorrhagic lesions or osteoporosis.

Clexane during pregnancy: consequences for the child

We never tire of repeating that Clexane can be used only after a thorough examination. If we talk about the effect on the fetus, there is no evidence that enoxaparin can penetrate the placenta, but there are no serious studies that would confirm the safety of the drug for a child.

Therefore, no one is in a hurry to immediately prescribe this remedy to a pregnant woman, but there are cases when it is simply necessary. For example, if a doctor sees thrombosis of the placenta beginning, this poses a serious danger to the child. At the beginning of pregnancy, this causes miscarriages, and in subsequent trimesters it leads to hypoxia, premature aging of the placenta and early birth.

Clexane: instructions for use during pregnancy

Clexane is available as an injection. The ampoules have different doses, which are prescribed only by the doctor in order to avoid side effects and so that the treatment is not excessive, but precise. If the doctor sees a possibility of developing thrombosis in a pregnant woman, then there is a need for preventive purposes to give 1 injection per day, 40 ml for 10-15 days. If treatment is being carried out and the problem already exists, then Clexane is injected once a day, and the volume is calculated based on the weight of the pregnant woman (1.5 mg per 1 kg).

As for the injections themselves, they are given differently from a regular injection. Clexane is injected into the stomach, and to achieve the correct effect, you need to know the rules of administration. By the way, don’t let the word “stab in the stomach” scare you, it’s even less painful than in a muscle. And you can give the injection yourself. Therefore, let’s look at how to inject Clexane into the stomach during pregnancy.

  1. Before you start the injection, you need to wash your hands very well and sit comfortably, or better yet, lie on your back.
  2. Treat the injection site well.
  3. Remove the cap from the syringe.
  4. As in a regular injection, in this one you don’t need to press on the piston to release air bubbles, as we always do, everything is already provided for, and we can lose drops of the expensive drug.
  5. Gather the skin on the abdomen with your thumb and forefinger to create a fold. The injection site should be at least 5-6 cm from the navel.
  6. Insert the needle along its entire length perpendicular to the surface of the abdomen.
  7. Inject the entire drug, then leave the fold alone and remove the needle without deviating its degree.

Do not give the next injections where there is already a mark from the previous injection. Give injections to different places in the abdomen each time.

Important! Do not rub the injection site. It is forbidden to administer Clexane intramuscularly.

Analogues of Clexane during pregnancy

In addition to Clexane, there are many antithrombotic drugs that are also actively used depending on the circumstances - in the postoperative period and at other times, but not all of these drugs can be used during pregnancy.

Complete analogues of clexane are:

  • Novoparin;
  • Warfarin;
  • Hemapaxan;
  • Wessel Due F.;
  • Anfiber;
  • Enoxarin;
  • Fragmin;
  • Angioflux;
  • Fraxiparine.

Analogs of Clexane differ in composition, mass of substance, and release form. All of them have different effects on the body of a pregnant woman. Therefore, you should never prescribe such medications yourself. Only a doctor can combine all your tests, which contain a great many different nuances, indicators, numbers, and prescribe you exactly that drug, and not that one.

The prescription of Fraxiparine is quite common and many are interested in which is better - Clexane or Fraxiparine during pregnancy. We certainly cannot answer this question in any way, the compositions are very similar, but for some pregnant women Fraxiparine is not suitable or, on the contrary, Clexane. And the most important thing is that the gynecologist, as a rule, consults with a hematologist (in any case, he should do this) and if the necessary tests are available, only they decide which drug to prescribe and in what dose.

Anticoagulant drugs include Clexane. This medicinal solution(color from transparent to pale yellow), reduces the likelihood of blood clots and helps stop the growth of existing ones. Below is a brief description of the drug Clexane 0.4, instructions for use of which are provided with the supply of the medicine itself.

In contact with

General information

The main pharmacological action of the drug is considered preventing blood clots. The main component of this drug is enoxaparin sodium. Without going into pharmacological terms, we note that this substance allows you to achieve a decrease in blood density and helps improve its general condition.

Storage conditions

Recommended storage temperature medicine is 25°C. If the application form is already in a syringe, then storage in a dark place, protected from sunlight and moisture, is recommended.
The reasons for this condition are the following factors:

  • direct exposure to sunlight (and ultraviolet radiation included) reduces the shelf life;
  • if purchased in powder form, then excess moisture can reduce the effect of the required medicine and affect its quality;
  • If you use a syringe with a medicinal substance, do not open it under any circumstances to avoid oxidation by air or evaporation.

Clexane 0.4 instructions for use

Typically, the most acceptable storage place is considered to be a sideboard or closet. As a last resort, storage in the refrigerator is permissible (it is dark and the temperature is appropriate). This drug should be stored out of reach of children. Best before date is 3 years.

How to take the medicine

Before injecting Clexane, we hasten to draw attention to the fact that the medicine is intended only for injection under the skin. Its intramuscular administration is strictly prohibited. Depending on the purpose for which this remedy is used, there are differences in approaches to its use.
The injection of the drug is carried out strictly into the abdominal cavity.

The approximate injection area is usually in the navel area (radius 10 to 15 cm, or the width of the palm).
The injection procedure is as follows:

  • the patient’s position (preferably) should be horizontal;
  • wash your hands thoroughly with soap;
  • treat the planned injection site (cotton wool or sponge in combination with medical alcohol, or boric acid);
  • prepare a syringe with Clexane solution (if there are air bubbles, there is no need to remove them);
  • We form a fold on the stomach (not very large);
  • insert the syringe over the entire length of the syringe needle (no more than 2 cm), inject;
  • hold the fold of skin on the abdomen until the medicine is completely administered;
  • After we have pulled out the needle, we again disinfect the injection site.

It may seem strange to many that bubbles do not come out of the syringe.

In fact, this is an indicator that the medical substance has been completely introduced and no damage will be caused to the body.

However, it is also allowed removing bubbles, the result will be the same.

The procedure itself is not painful and does not represent anything complicated, thereby answering the question: “Clexane, where to inject?”

The main thing to remember is that the drug is administered only into the abdominal cavity.

And if you have any difficulties understanding, we will inform you that for each package of Clexane 0.4 the instructions contain graphic tips on how to do it correctly.

Depending on the prescribed dosage, there are the following forms of injection solution: glass syringe with a volume of 0.2, 0.4, 0.6, 0.8 and 1 ml. The drug is sold in a package of 2 syringes, protected by a blister.

Important! We note the fact that using a solution of the drug with an expired release date is strictly prohibited!

More clear instructions for use are supplied with the drug.

Depending on the patient’s condition and the purpose of using the medicine, there are different dosages.

If the injection is given for prophylactic purposes, then, depending on weight, solutions from 20 to 40 mg can be prescribed once a day.

If severe renal failure is observed, the maximum volume will not exceed 0.2 ml 1 time per 24 hours.

Adjustment of the volume of injected Clexane solution must be carried out by the attending doctor.

If diseases such as myocardial infarction, angina pectoris, deep vein thrombosis, etc. are observed.

Strictly the use of the solution is prohibited during hemodialysis.

Attention! If there was an overdose of the treatment solution Clexane 0.4, then protamine sulfate will be required for neutralization. The total amount of “antidote” is calculated from 1 mg Clexane = 1 mg sulfate (the ratio is valid in the first 8 hours). After more than 8 hours, the following ratio is used: for each mg of medication - 0.5 mg of protamine sulfate. If more than 12 hours have passed, no “antidote” will be required.

Use during pregnancy

There is no substantial data prohibiting the use of this medicine by women during pregnancy. However, from the essence of its purpose it is clear why it is prescribed - preventing blood clots.

If pregnancy occurs during IVF, the reasons for its use may be:

  1. Reduced blood density (its thinning).
  2. As a prevention against blood clots.
  3. Providing the fetus with normal blood flow (during pregnancy, the blood becomes “thicker” in order to reduce the volume of blood that will be lost during childbirth).

But we also note that the effect of the medicine on a woman and child during the 1st to 3rd trimester has not been fully studied.

In fact, the justified use of this substance is rational if it brings more benefit to the mother and child than harm.

If pregnant women need the medicine, then before injecting Clexane, you must consult a doctor.

If during the period of feeding the baby into breast milk enoxaparin will be released– You must stop using it immediately. Looking ahead, we will inform you that the medicine Clexane and alcohol during pregnancy are strictly incompatible!

Possible consequences

One possible side effect may be bleeding. If this happens, the medication should be stopped immediately. After which immediately required to undergo examination and find out the reasons for this result, only after the doctor’s recommendation to continue use.

In rare cases, hemorrhagic syndrome develops (i.e. a rash all over the body with dots up to 3 mm in diameter, bruises on the skin and mucous membrane, low blood clotting, bleeding, etc.), which subsequently appears as a hemorrhage in the skull, damage to the body is possible, incompatible with life.
If the drug is administered to a patient while a catheter is being used or while spinal anesthesia is being used, neurological damage may occur that will manifest itself later. in the form of paresis or paralysis.

In the first days of use, the total number of platelets in the blood may be reduced, which will manifest itself in the form of decreased blood clotting.

However, this indicator is not a compelling argument for discontinuing the use of the drug, and is considered temporary, even when using Clexane during pregnancy.

During use, the patient may experience an erythematous rash in the form of plaques (may appear pink in color with flaky skin).

This side effect eventually “transforms” into necrosis of living tissue.

If the first “cans” are detected, the drug should be stopped. Therefore, Clexane, the side effects of which may cause serious harm, should be taken with extreme caution and care.

Clexane can cause an allergic reaction expressed in the form of skin breakdown. In advanced cases, vasculitis may form. If you notice this effect, you should see a doctor as soon as possible.

Similar medicines of the same direction

Among the most “related” in properties are the following substitutes:

  • Flenox,
  • Novoparin,
  • Gisende,
  • Heparin,
  • Aksparin,
  • Fraxiparine
  • and others.

In all medicines contain enoxaparin sodium itself. These drugs are produced in powder form for subsequent preparation of solution and injection.

In terms of price, the price range depends on the country of origin (domestic and imported), as well as on the dosage.

For example, the same Flenox, in a dosage of 0.4, will cost about 980 rubles, and Novoparin produced in Ukraine can cost no more than 567 rubles.

Fraxiparine from the same family can reach astronomical prices (the price difference ranges from 1800 to 2500 rubles).

Imported analogues differ significantly in price. Using Novoparin as an example, after a brief monitoring, you can find out that an English-made product (dosage 0.4) will cost about 800 rubles. The easiest way to find Novoparin is due to its lower price and prevalence. Those. Clexane, analogues of which were presented above, is a rather specific remedy for which you can choose a cheaper replacement.

The closest Fraxiparine is considered an analogue, as an equivalent substitute. Due to the similarity of medications, many people have a reasonable question: “Fraxiparine or Clexane, which is better?”

In essence, these two drugs are equivalent. As pharmacists and doctors note, the main difference lies in the amount (percentage) of the active substance - enoxaparin sodium.

Important! It is obvious that they do not skimp on health. But the high cost of the necessary medications sometimes makes you think about possible analogues of the drug, and sometimes even stop the treatment process altogether.

Before purchasing a “replacement” in any case, you should consult your doctor. Because an incorrectly selected “double” of the drug Clexane can lead to the following consequences:

  • allergic reactions with possible consequences;
  • deterioration of the patient’s condition due to unacceptable substances in the composition;
  • side effects of the analogue, which can correct treatment in the wrong direction;
  • possible zero effect, etc.

The essence of these drugs is that they, as it were, thin the blood, relieving it of excess “density”.

Otherwise, the drugs are quite similar and can be used to prevent blood clots. In terms of price, a syringe of Clexane medication will vary between 2,700 rubles, and the price of its “double” will range from 2,900 to 3,400 rubles.

Both drugs are sold in sufficient quantities, and there are no problems with their supply.

Those. the risk of replacement is quite high, and the desire to save money will result in additional costs at best. Therefore, if you want to buy an effective drug substitute, first check its name, dosage and cost, and then consult your doctor about its possible use.

Clexane and booze

Particularly acute contraindications compatibility these two substances do not exist. But their simultaneous entry into the human body is unacceptable if:

  • if an alcoholic drink and medicine are consumed at the same time;
  • It is inadmissible to use Clexane during pregnancy at any stage;
  • During the course of treatment it is strictly prohibited to drink alcohol.

In other cases these two substances are compatible, if at least 24 hours have passed between their introduction into the body. If these substances were consumed less than 20 hours apart, try to drink as much water as possible in the next 4 hours (clean, not soda or anything like that), while completely eliminating the use of strong drinks.

As a consolation, we can say that if such an accident occurred for the first time, there will be no serious consequences. Obvious side effects may include: nausea, vomiting, headaches, redness, limb cramps, etc.

Video: how to put Clexane correctly

Clexane, despite its narrow specialty, is quite strong remedy, capable of harming a person. Its use is permissible only on the recommendation of the attending physician. Otherwise, negative consequences are possible, which in turn can lead to new health problems.

These are common diseases that almost everyone faces. If appropriate treatment is not provided in time, serious consequences may ultimately occur, including death.

Modern pharmacological companies provide a huge selection of drugs for the treatment of these diseases. Each of them can not only relieve pain, but also the inflammatory process.

These drugs include the drug Clexane. It has not only anti-inflammatory properties, but also a general strengthening effect, so it is often prescribed during prophylaxis before and after operations.

general information

Clexane is a medicine that belongs to the group. The drug is used for thrombosis and embolism. The active component of the product is enoxaparin sodium.

This component is also called heparin, which is in a low molecular state, obtained by hydrolysis of heparin with alkali (as an ester in benzyl form).

The main raw material for enoxaparin sodium is heparin, which is obtained from the intestinal mucosa of thin pigs.

Clexane contains the active substance enexparin sodium and a clear liquid with a yellow tint for injection.

Available in the form of syringes filled with a clear liquid for injection under the skin. Syringes are available in different volumes - 0.2 ml, 0.4 ml, 0.6 ml, 0.8 ml and 1 ml, which contain 20 mg, 40 mg, 60 mg, 80 mg and 1 gram of the main component - enexoparin and water for injection as a solvent. 1 blister contains 2 syringes.

Pharmacological properties and pharmacodynamics

Clexane has antithrombotic properties. It is used as an injection under the skin during the treatment of acute coronary syndrome, deep vein thrombosis, and also as a preventive treatment for various venous pathologies.

The second international nonproprietary name for this drug is enoxaparin. The drug is a low molecular weight heparin with a molecular weight of approximately 4500 daltons.

While using the product for prophylactic treatment, he experiences a slight change in activated partial thromboplastin time. It also has almost no effect on platelet status and fibrogen binding. Also, during the treatment of various diseases with this drug, the aPTT increases almost 1.5-2 times.

After prolonged subcutaneous injections of a systematic nature in a volume of 1.5 mg per 1 kilogram of body weight, the maximum level of enoxaparin sodium in the body is reached after two days. Bioavailability during subcutaneous administration is 100%.

Metabolization of enoxaparin in the liver is achieved through desulfation and depolymerization. The metabolites that are formed during this process have low activity.

The half-life of the drug lasts from 4 hours to 5 hours during a single dose. If the medicine is taken repeatedly – ​​7 hours. About 40% of the drug is excreted through the kidneys. The elimination of the active substance enexoparin in older people occurs more slowly, this is due to deterioration of kidney function.

Indications for use

The main purpose of Clexane is to use it during preventive treatment for venous thrombosis, embolism, thromboembolism.

Clexane injections are also prescribed for the following indications:

  • recommended for patients who are on bed rest, who have suffered acute therapeutic diseases - severe infectious diseases, the presence of respiratory and heart failure, chronic heart failure, acute rheumatic diseases with presence of risk factors for thrombus formation;
  • during surgical interventions;
  • prescribed for hemodialysis, but provided that the procedure lasts no more than 4 hours;
  • during varicose veins of deep veins which may or may not be accompanied by pulmonary embolism;
  • prescribed for unstable rhythm of angina pectoris and myocardial infarction. And also during acute myocardial infarction in patients who receive drug treatment procedures with coronary intervention.

Assignment restrictions

According to the instructions, the drug is not recommended for use for the following indications:

  • in the presence of increased sensitivity of the body to the main component– enoxaparin sodium, as well as heparin and its derivative components;
  • should not be taken under 18 years of age;
  • all kinds of diseases and conditions that are accompanied by an increased risk of severe bleeding - these include hemorrhagic stroke, aneurysm of the aorta or cerebral vessels of the head, as well as in the presence of enoxaparin- and heparin-induced thrombocytopenia in severe form, uncontrolled bleeding.

It is also worth paying attention to the fact that the drug should be used with extreme caution in the following conditions:

  • in the presence of renal or liver failure;
  • if there is a peptic ulcer of the stomach or duodenum, as well as any other erosive and ulcerative lesions of the gastrointestinal tract;
  • with severe diabetes mellitus;
  • for retinopathy of hemorrhagic or diabetic type;
  • severe vasculitis;
  • problems with hemostasis;
  • bacterial endocarditis;
  • with uncontrolled arterial hypertension of a severe type;
  • when performing epidural or spinal anesthesia;
  • if there are severe injuries associated with the central nervous system;
  • if you have intrauterine contraception;
  • in the presence of extensive wounds with severe bleeding;
  • when taken simultaneously with drugs that affect the homeostasis system.

During pregnancy and lactation

The drug Clexane is prescribed during pregnancy in rare cases. It is usually prescribed when the expected therapeutic effect for the mother is higher than the potential benefit for the child.

In addition, there is no information about whether enoxaparin sodium crosses the placental barrier during pregnancy.

If treatment with the drug is necessary during breastfeeding, then feeding should be stopped for the period of treatment.

Rules for use and dosage

The solution is administered using the injection method, with the patient in a supine position. The medicine is injected into the anterior or posterolateral abdominal wall at the site of the belt.

The needle should be inserted vertically completely, into the layer of skin that is sandwiched in the form of a fold. After insertion, the fold is not straightened. It is worth considering that after the injection the area does not need to be rubbed.

For venous thrombosis, varicose veins and thromboembolism

If the disease has an average form of development with a slightly pronounced risk, Clexane is used 20 mg (0.2 g) for subcutaneous administration once a day.

The medication is injected 2 hours before the operation and continues as long as there is a possibility of thromboembolic complications. The duration of the injections lasts about a week.

If the disease is severe, the drug is used at a dose of 40 mg (0.4 g) for subcutaneous administration once a day. The first administration is carried out 12 hours before surgery, and continues in the subsequent period, as long as there is a possibility of thromboembolic complications. Injections are given for approximately 10 days.

How to inject Clexane yourself - visual video:

Treatment of deep vein thrombosis

During deep vein thrombosis, the drug is prescribed in a dosage of 1 gram for injection under the skin. Injections are administered every up to 2 times a day every 12 hours.

Treatment with oral anticoagulants is prescribed simultaneously with Clexane. The course of injections is 10 days.

Side effects

The instructions indicate side effects that may occur when using the drug:

  • bleeding;
  • the occurrence of thrombocytopenia;
  • skin rashes;
  • the occurrence of allergies, which may be systemic.

In addition, after administration of the drug, local reactions may occur - pain at the injection site, the appearance of hematomas, and in rare cases, necrosis.

Also, many expert reviews note that with long-term treatment with this drug there may be a risk of developing osteoporosis.

Opinions of specialists in various fields

From doctors' reviews about the drug Clexane.

In my opinion, the drug Clexane is a good remedy for the treatment of thrombosis, embolism and thromboembolism.

In all my practice of using this drug, I can say with confidence that this remedy has a positive effect and leads to a rapid recovery. But still, it should be used only according to indications and only after a doctor’s prescription.

Vascular surgeon

The drug Clexane works well both in the treatment of heart failure, myocardial infarction, and various vein diseases - varicose veins, thrombosis, embolism, thromboembolism. This drug has undergone clinical trials and has proven its effectiveness. However, do not forget about side effects and contraindications; it is not advisable to use this remedy for hemorrhagic diseases and other conditions specified in the instructions.

Cardiologist

Voice of the People

Patients' thoughts.

My doctor prescribed Clexane to me to treat vein thrombosis. I did it in accordance with the instructions before the operation and subsequently in the subsequent period. My entire course of treatment lasted a week.

After treatment, I noticed relief, the pain went away, inflammation and heaviness went away. However, this product still has many contraindications and side effects, but it is so effective!

Lyudmila, 48 years old

I was prescribed the drug Clexane for the treatment of deep vein varicose veins and thrombosis. I have a high-risk disease.

I was given it at a dosage of 40 mg, first before the operation, then in the subsequent period. I received 10 injections in total. Of course, the condition has improved, but not by much. Perhaps I have a severe lesion and an advanced disease. And there are too many contraindications.

Mikhail, 52 years old

Price issue

The cost of the drug Clexane depends on the form of release and the volume of the syringe:

  • 0.2 grams 10 pieces - from 1,750 rubles;
  • 0.4 grams 10 pieces – from 2900 rubles;
  • 0.6 grams 2 pieces – from 880 rubles;
  • 0.8 grams 10 pieces – from 5000 rubles.
  • Fragmin;
  • Cibor;
  • Ostohont;
  • Gepalpan;
  • Troparin lmv.

Name:

Clexane

Pharmacological
action:

A drug low molecular weight heparin(molecular weight about 4500 daltons: less than 2000 daltons -< 20%, от 2000 до 8000 дальтон - >68%, more than 8000 daltons -< 18%).
Enoxaparin sodium 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 a purified in vitro system, enoxaparin sodium has high anti-Xa activity (approximately 100 IU/ml) and low anti-IIa or antithrombin activity (approximately 28 IU/ml).
This anticoagulant activity acts through antithrombin III(AT-III), providing anticoagulant activity in humans.

In addition to anti-Xa/IIa activity, additional anticoagulant and anti-inflammatory properties of enoxaparin sodium have also been identified both in healthy humans and patients, and in animal models.
This includes AT-III-dependent inhibition of other coagulation factors such as factor VIIa, activation of tissue factor pathway inhibitor (TFP) release, and decreased release of von Willebrand factor from the vascular endothelium into the bloodstream. These factors provide the anticoagulant effect of enoxaparin sodium in general.
When using the drug in prophylactic doses, it slightly changes the aPTT, almost has no effect on platelet aggregation and the level of fibrinogen binding to platelet receptors.
Anti-IIa activity in plasma is approximately 10 times lower than anti-Xa activity.
The average maximum anti-IIa 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 for a double dose and 1.5 mg/kg body weight for a single dose. introduction accordingly.
The average maximum anti-Xa activity of plasma is observed 3-5 hours after subcutaneous administration of the drug and is approximately 0.2, 0.4, 1.0 and 1.3 anti-Xa IU/ml after subcutaneous administration of 20, 40 mg and 1 mg/kg and 1.5 mg/kg respectively.

Pharmacokinetics
The pharmacokinetics of enoxaparin in the indicated dosage regimens is linear.
Suction and distribution
After repeated subcutaneous injections of enoxaparin sodium at a dose of 40 mg and at a dose of 1.5 mg/kg body weight 1 time/day in healthy volunteers, Css is achieved by day 2, and AUC is on average 15% higher than after a single administration. After repeated subcutaneous injections of enoxaparin sodium at a daily dose of 1 mg/kg body weight 2 times/day, Css is achieved after 3-4 days, with AUC on average 65% higher than after a single dose and average Cmax values ​​of 1.2 IU, respectively. /ml and 0.52 IU/ml.
The bioavailability of enoxaparin sodium after subcutaneous administration, assessed on the basis of anti-Xa activity, is close to 100%. The Vd of enoxaparin sodium (based on anti-Xa activity) is approximately 5 liters and is close to the blood volume.
Metabolism
Enoxaparin sodium is mainly biotransformed in the liver by desulfation and/or depolymerization to form low molecular weight substances with very low biological activity.

Removal
Enoxaparin sodium is a drug with low clearance. After intravenous administration for 6 hours at a dose of 1.5 mg/kg body weight, the average clearance of anti-Xa in plasma is 0.74 l/h.
The elimination of the drug is monophasic. T1/2 is 4 hours (after a single subcutaneous injection) and 7 hours (after repeated administration of the drug). 40% of the administered dose is excreted by the kidneys, with 10% unchanged.
Pharmacokinetics in special clinical situations
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 mild (creatinine clearance 50-80 ml/min) and moderate (creatinine clearance 30-50 ml/min) renal impairment, after repeated subcutaneous administration of 40 mg enoxaparin sodium 1 time/day, there is an increase in anti-Xa activity, represented by AUC . In patients with severe renal impairment (creatinine clearance less than 30 ml/min), with repeated subcutaneous administration of the drug at a dose of 40 mg 1 time/day, the AUC at steady state is on average 65% higher.
In patients with excess body weight, with subcutaneous administration of the drug, the clearance is slightly less. If you do not adjust the dose taking into account the patient's body weight, then after a single subcutaneous injection of enoxaparin sodium at a dose of 40 mg, anti-Xa activity will be 50% higher in women weighing less than 45 kg and 27% higher in men with weight body weight less than 57 kg, compared with patients with normal average body weight.

Indications for
application:

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 stage of decompensation of functional class III or IV 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 thromboembolism of the pulmonary artery;
- 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.

Mode of application:

Clexane is intended only for subcutaneous administration, administering it intramuscularly is contraindicated.
Prevention of thrombosis during surgical interventions
For abdominal operations, 20-40 mg once a day subcutaneously, the initial dose is administered 2 hours before surgery.
For orthopedic operations, 40 mg once a day subcutaneously, the initial dose is administered 12 hours before surgery.
An alternative regimen for administering Clexane 30 mg twice a day is possible, the initial dose is administered 12-24 hours after surgery.
The course of therapy is 7-10 days, but if necessary can be extended as long as the risk of thrombosis remains (usually no longer than 5 weeks).
Prevention of thromboembolism and venous thrombosis during forced long-term bed rest
It is recommended to use Clexane in a dose of 40 mg once, subcutaneously, for a course of therapy of 6-14 days.

Prevention of thrombosis during hemodialysis
It is recommended to administer Clexane at a dose of 1 mg/kg body weight once a day; in the presence of risk factors for bleeding, it is recommended to reduce the dose to 0.5 mg/kg body weight once a day if double vascular access is possible or 0.75 mg if a single vascular access is available.
In this procedure, Clexane is injected into the arterial part of the shunt before hemodialysis begins. One dose of Clexane is sufficient for a four-hour session; for a longer hemodialysis session, additional administration of the drug at the rate of 0.5 - 1 mg/kg body weight may be required.
Treatment of deep vein thrombosis
It is recommended to administer Clexane at a dose of 1.5 mg/kg body weight once a day or at a dose of 1 mg/kg body weight twice a day. In the presence of thromboembolic complications, it is recommended to administer Clexane at a dose of 1 mg/kg body weight twice a day.
The average course of therapy is 10 days.

Treatment of coronary heart disease (unstable angina, myocardial infarction without the presence of a pathological Q wave)
It is recommended to administer Clexane at a dose of 1 mg/kg body weight twice a day, simultaneously with the administration of acetylsalicylic acid at a dose of 100-325 mg once a day.
The course of therapy is 2-8 days.
For patients with renal failure, correction is required only when creatinine clearance is less than 30 ml/min.
In this case, the drug is administered at the rate of 1 mg/kg body weight for therapeutic purposes and 20 mg once a day for prophylactic purposes. For mild or moderate deficiency, Clexane can be administered in the usual dosage.
The administration of Clexane should be carried out when the patient is in a supine position, the drug is injected subcutaneously deep (the entire length of the needle vertically) into the inferolateral or superolateral part of the anterior abdominal wall on the left or right.
The release form of Clexane is a pre-filled syringe that is completely ready for use. There is no need to remove air bubbles from the syringe, this avoids loss of the drug.

Side effects:

The side effects of enoxaparin sodium were studied in more than 15,000 patients participating in clinical trials.
Prevention of venous thrombosis and embolism during general surgery and orthopedic operations - 1776 patients.
Prevention of venous thrombosis and embolism in patients on bed rest due to acute therapeutic diseases - 1169 patients.
Treatment of deep vein thrombosis with or without pulmonary embolism - 559 patients.
Treatment of unstable angina and myocardial infarction without Q wave - 1578 patients.
Treatment of myocardial infarction with ST segment elevation - 10,176 patients. The mode of administration of enoxaparin sodium differed depending on the indication.

For the prevention of venous thrombosis and embolism during general surgical and orthopedic operations or in patients on bed rest, the dose was 40 mg subcutaneously once.
When treating deep vein thrombosis with or without pulmonary embolism, patients received enoxaparin sodium at the rate of 1 mg/kg body weight subcutaneously every 12 hours or 1.5 mg/kg body weight sc once a day.
In the treatment of unstable angina and myocardial infarction without a Q wave, the dose of enoxaparin sodium was 1 mg/kg body weight subcutaneously every 12 hours, and in the case of myocardial infarction with ST-segment elevation - 30 mg by bolus administration followed by a dose of 1 mg/day. kg body weight s.c. every 12 hours.
Determination of the frequency of adverse reactions: very often (≥1/10), often (≥1/100 -<1/10), нечасто (≥1/1000 - <1/100), редко (≥1/10 000 - <1/1000), очень редко (<1/10 000).

Bleeding
Bleeding was the most common side effect.
It occurred in 4.2% of cases and was considered significant if it was accompanied by a decrease in hemoglobin content by 2 g/l or more, required transfusion of 2 or more doses of blood components, and also if it was retroperitoneal or intracranial. Some of these cases were fatal.
As with the use of other anticoagulants, bleeding may occur, especially in the presence of concomitant risk factors that contribute to the development of bleeding, during invasive procedures or the use of drugs that impair hemostasis.
Very often - bleeding during the prevention of venous thrombosis in surgical patients and the treatment of deep vein thrombosis with or without thromboembolism.
Often - bleeding during the prevention of venous thrombosis in patients on bed rest and during the treatment of angina pectoris, myocardial infarction without a Q wave and myocardial infarction with ST segment elevation.
Uncommon: retroperitoneal bleeding and intracranial bleeding in patients treated for deep vein thrombosis with or without thromboembolism, as well as ST-segment elevation myocardial infarction.
Rarely - retroperitoneal bleeding in the prevention of venous thrombosis in surgical patients and in the treatment of angina pectoris, myocardial infarction without a Q wave.
When using Clexane against the background of spinal/epidural anesthesia and postoperative use of penetrating catheters, cases of the formation of neuraxial hematomas have been described, leading to neurological disorders of varying severity, including long-term or irreversible paralysis.

Thrombocytopenia and thrombocytosis
Very often - thrombocytosis in the prevention of venous thrombosis in surgical patients and the treatment of deep vein thrombosis with or without thromboembolism.
Often - thrombocytopenia in the prevention of venous thrombosis in surgical patients and the treatment of deep vein thrombosis with or without thromboembolism, as well as in myocardial infarction with ST segment elevation.
Uncommon - thrombocytopenia in the prevention of venous thrombosis in patients on bed rest and in the treatment of angina pectoris, myocardial infarction without a Q wave.
Very rarely - autoimmune thrombocytopenia during myocardial infarction with ST segment elevation.
In rare cases, the development of autoimmune thrombocytopenia in combination with thrombosis. In some of them, thrombosis was complicated by organ infarction or limb ischemia.

Others
Very often - increased activity of liver transaminases.
Often - allergic reactions, urticaria, itching, redness of the skin, hematoma and pain at the injection site.
Uncommon: skin (bullous rashes), inflammatory reaction at the injection site, skin necrosis at the injection site.
Rarely - anaphylactic and anaphylactoid reactions, hyperkalemia. Skin necrosis may develop at the injection site, preceded by the appearance of purpura or erythematous painful papules. In these cases, therapy with Clexane should be discontinued. The formation of hard inflammatory nodules-infiltrates at the injection site of the drug is possible, which disappear after a few days and are not grounds for discontinuation of the drug.

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 not recommended drug in pregnant women with artificial heart valves.
Carefully used for the following conditions:
- hemostasis disorders (including hemophilia, thrombocytopenia, hypocoagulation, von Willebrand disease);
- severe vasculitis;
- peptic ulcer of the stomach and duodenum or other erosive and ulcerative lesions of the gastrointestinal tract;
- recent ischemic stroke;
- uncontrolled severe arterial hypertension;
- diabetic or hemorrhagic retinopathy;
- severe diabetes mellitus;
- recent or proposed neurological or ophthalmological surgery;
- performing spinal or epidural anesthesia (potential danger of hematoma development);
- spinal puncture (recently undergone);
- recent birth;
- bacterial endocarditis (acute or subacute);
- pericarditis or pericardial effusion;
- renal and/or liver failure;
- intrauterine contraception;
- severe trauma (especially the central nervous system);
- open wounds with a large wound surface;
- simultaneous use of drugs that affect the hemostatic system.
There is no data on the clinical use of Clexane in the following conditions: active tuberculosis, radiation therapy (recently administered).

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).
Recommended Carrying out careful monitoring of the patient's condition.
It is recommended that the use of drugs that can impair hemostasis (salicylates, acetylsalicylic acid, NSAIDs, including ketorolac; dextran with a molecular weight of 40 kDa, ticlopidine, clopidogrel; corticosteroids, thrombolytics, anticoagulants, antiplatelet agents, including antagonists of glycoprotein receptors IIb/IIIa) should be discontinued until starting treatment with enoxaparin sodium, unless their use is 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-Xa 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-Xa 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.
Risk of autoimmune thrombocytopenia induced 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/day or 1.5 mg/kg 1 time/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 necessary, 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 history, in vitro 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 following 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 machinery.

Interaction
other medicinal
by other means:

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-Xa activity, units of measurement and dosage. And, as a consequence of this, the drugs have different pharmacokinetics and biological activities (anti-IIa activity, interaction with platelets).
With systemic salicylates, acetylsalicylic acid, NSAIDs (including ketorolac), dextran with a molecular weight of 40 kDa, ticlopidine and clopidogrel, systemic corticosteroids, thrombolytics or anticoagulants, and other antiplatelet drugs (including glycoprotein IIb/IIIa antagonists), the risk of bleeding increases.

Pregnancy:

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 second trimester; there is no information regarding the first and third trimesters of pregnancy.
When using Clexane during lactation, breastfeeding should be stopped.

Overdose:

Symptoms: Accidental overdose by IV, extracorporeal or subcutaneous administration can lead to hemorrhagic complications. When taken orally, even in large doses, absorption of the drug is unlikely.
Treatment: slow intravenous administration of protamine sulfate is indicated as a neutralizing agent, the dose of which depends on the dose of Clexane administered.
It should be taken into account that 1 mg of protamine neutralizes the anticoagulant effect of 1 mg of enoxaparin if Clexane was administered no more than 8 hours before the administration of protamine. 0.5 mg of protamine neutralizes the anticoagulant effect of 1 mg of Clexane if it was administered more than 8 hours ago or if a second dose of protamine is necessary. : water d/i.

Low molecular weight heparin (average molecular weight about 4500 Da), in which the antithrombotic and anticoagulant activities of standard heparin are separated. Unlike standard unfractionated heparin, it is characterized by high anti-Xa activity (100 IU/ml) and weak anti-IIa or antithrombin activity (28 IU/ml). When used in recommended doses, enoxaparin sodium does not increase bleeding time. In prophylactic doses, enoxaparin sodium does not lead to significant changes in activated partial thromboplastin time (aPTT), and also does not affect platelet aggregation and fibrinogen binding to platelets.
The pharmacokinetic parameters of the drug are assessed by changes in anti-Xa and anti-IIa activity in blood plasma over time in the recommended dose ranges.
When administered subcutaneously, Clexane is quickly and almost completely absorbed. Absorption is directly proportional to the administered dose and is linear. The bioavailability of enoxaparin sodium when administered subcutaneously approaches 100%. Maximum anti-Xa activity in blood plasma is observed between the 3rd and 5th hour after subcutaneous administration and averages 0.18±0.04 IU/ml after administration of 2000 anti-Xa IU and 0. 43±0.11 IU/ml after administration of 4000 anti-Xa IU, and 1.01±0.14 IU/ml after administration of 10,000 anti-Xa IU. Maximum anti-IIa activity is observed on average 4 hours after subcutaneous administration at a dose of 4000 anti-Xa IU, while at the same time, when administered at a dose of 2000 anti-Xa IU, this activity cannot be determined by the traditional amidolytic method. The volume of distribution of enoxaparin sodium for anti-Xa activity almost corresponds to the volume of circulating blood.
Metabolism of enoxaparin sodium occurs in the liver by desulfation and/or depolymerization to form low molecular weight heparin species with significantly lower biological potential. The half-life of anti-Xa activity corresponds to approximately 4 hours with a single dose and 7 hours with repeated administration. Anti-Xa activity is detectable up to approximately 24 hours after subcutaneous administration of 4000 anti-Xa IU enoxaparin sodium. Renal clearance of active metabolites is 10%, total renal excretion is 40% of the drug dose. Elimination of enoxaparin is longer in the elderly (half-life is 6-7 hours). In patients with renal failure (creatinine clearance ≤30 ml/min), AUC increases significantly (by 65%) with repeated administration of 4000 anti-Xa IU once daily. Pharmacokinetic parameters in patients with renal failure on hemodialysis do not change.

Indications for use of the drug Clexane

Prevention of venous thrombosis and embolism during orthopedic or general surgical operations, as well as in therapeutic patients on bed rest due to acute diseases (heart failure of functional class III-IV according to the NYHA classification, respiratory failure, severe acute infectious process, rheumatic diseases) ; prevention of thrombus formation in the extracorporeal circuit during hemodialysis; treatment of deep vein thrombosis, including those accompanied by pulmonary embolism; treatment of unstable angina and acute myocardial infarction without pathological wave Q(in combination with acetylsalicylic acid).

Use of the drug Clexane

The drug is used only in adults. For prophylactic and therapeutic use, enoxaparin is administered deeply subcutaneously. The drug is administered intravenously to achieve anticoagulation during hemodialysis.
Enoxaparin cannot be administered intramuscularly! Clexane is injected into the antero- or posterolateral area of ​​the abdominal wall. The syringe needle is inserted over its entire length in a perpendicular direction to the surface of the skin fold, which is formed using the thumb and index finger and held throughout the entire injection. The patient should be in a supine position. 1 mg of enoxaparin sodium (0.01 ml solution) corresponds to approximately 100 anti-Xa IU activity.
For the prevention of venous thrombosis and thromboembolism during operations with a moderate risk of thrombus formation (abdominal surgery) and in patients with a moderate risk of thromboembolism, the drug is recommended to be administered subcutaneously at a dose of 2000 anti-Xa IU once a day. For operations with a high risk of thromboembolism (surgeries on the hip or knee joint and oncological interventions), the drug is administered subcutaneously at a dose of 4000 anti-Xa IU once a day. In general surgical practice, the first dose of the drug is administered 2 hours before surgery. In orthopedic practice, the first dose of the drug is administered 12 hours before surgery. The duration of prophylactic use is on average 7-10 days. In orthopedics, it is used in a dose of 4000 anti-Xa once a day for up to 4 weeks.
In immobilized medical patients at high risk of thromboembolism, the recommended dose is 4000 anti-Xa IU once daily for at least 6 days, but not more than 14 days.
To prevent thrombus formation in the extracorporeal circuit during hemodialysis, the drug is used at a dose of 100 anti-Xa IU/kg of patient body weight. Enoxaparin is injected into the arterial line of the hemodialysis circuit before the start of the session. As a rule, the indicated dose is sufficient for dialysis for 4 hours; when fibrin rings appear, an additional dose of 50-100 anti-Xa IU/kg can be administered. For patients with a high risk of bleeding, the dose of the drug should be reduced to 50 anti-Xa IU/kg with dual vascular access and to anti-Xa IU/kg with single access. When fibrin rings appear, an additional dose of 50 to 100 anti-Xa IU/kg is administered.
In the treatment of deep vein thrombosis, which is accompanied or not accompanied by pulmonary embolism, enoxaparin sodium is administered subcutaneously at a dose of 150 anti-Xa IU/kg once a day or at a dose of 100 anti-Xa IU/kg 2 times a day every 12 h. The duration of treatment should not exceed 10 days. If necessary, oral anticoagulants are simultaneously prescribed. Treatment is continued until the international normalization ratio (INR) reaches 2-3.
In the treatment of unstable angina and myocardial infarction without a pathological wave Q in the acute phase, enoxaparin sodium is administered subcutaneously at a dose of 100 anti-Xa IU/kg every 12 hours (in combination with acetylsalicylic acid at a dose of 100-325 mg once a day orally). The duration of treatment is 2-8 days until the patient’s condition is clinically stabilized.
There is no need for dose adjustment in elderly patients with normal renal function.
The use of enoxaparin sodium in children is not recommended.
In patients with renal failure (creatinine clearance ≤30 ml/min), dose adjustment of the drug is required, since its effect in this category of patients is significantly enhanced. For prophylactic purposes, such patients are prescribed the drug in a dose of 20 mg (2000 anti-Xa IU) once a day, for therapeutic purposes - 1 mg/kg (100 anti-Xa IU/kg) once a day.
Administration of the drug to patients with liver failure requires medical supervision.

Contraindications to the use of the drug Clexane

Hypersensitivity to enoxaparin or other low molecular weight heparins, acute hemorrhage or high risk of uncontrolled bleeding, including recent bleeding.

Side effects of the drug Clexane

Hemorrhagic complications are possible (including isolated cases of massive bleeding, in particular retroperitoneal and intracranial; some of these cases were fatal); local or generalized allergic reactions; thrombocytopenia (mild, transient, asymptomatic thrombocytopenia in the first days of therapy; immunoallergic thrombocytopenia with thrombosis, which in some cases was complicated by organ infarction or limb ischemia); with prolonged treatment (more than 5 weeks) - early development of osteoporosis; increased activity of transaminases in blood serum; the development of neuraxial hematomas when using enoxaparin during epidural or spinal anesthesia in some cases can lead to neurological disorders of varying severity, including the formation of prolonged or permanent paralysis; reactions at the injection site (from mild irritation to pain, bruising and hematomas at the injection site, in exceptional cases - skin necrosis); skin bullous rashes or systemic allergic reactions, including anaphylactoid. If such side effects occur, treatment with the drug must be stopped.
Isolated cases of hypersensitivity with cutaneous vasculitis have been reported; asymptomatic and reversible increase in platelet count and increase in liver enzyme activity.

Special instructions for the use of the drug Clexane

Low molecular weight heparins are not interchangeable drugs, since they differ in molecular weight, specific activity against factor Xa, and dosage regimen.
Clexane, like other anticoagulants, should be used with caution in conditions that are accompanied by an increased risk of bleeding, namely: with impaired hemostasis, a history of peptic ulcers, recent history of peptic ulcers, uncontrolled severe hypertension (arterial hypertension), diabetic retinopathy, neurosurgical or ophthalmological surgical interventions, simultaneous use of drugs that affect hemostasis.
During prophylactic treatment of patients over 65 years of age, no increased bleeding was observed, however, when using the drug in therapeutic doses, there may be a risk of developing hemorrhagic complications.
Since there are not enough controlled clinical studies in pregnant women, enoxaparin sodium should be prescribed during pregnancy only if there is a vital indication. It is not recommended to use Clexane for the treatment of pregnant women with prosthetic heart valves. It is recommended to stop breastfeeding during treatment with the drug.
Not used in pediatric practice.
In patients with low body weight (less than 45 kg in women and 57 kg in men), the risk of developing hemorrhagic complications increases, which requires monitoring the patient.
In order to reduce the risk of bleeding after percutaneous coronary angioplasty, the catheter providing vascular access should be removed no earlier than 6-8 hours after subcutaneous administration of enoxaparin. The next dose of enoxaparin can be administered only 6-8 hours after removal of the catheter.
When performing spinal or epidural anesthesia with the use of enoxaparin sodium at a dose of 4000 anti-Xa IU/kg once a day, cases of the development of neuraxial hematomas and associated neurological disorders were rarely observed. The risk of developing such complications increases with the use of enoxaparin sodium in high doses, the use of permanent postoperative epidural catheters, or the simultaneous use of drugs that affect hemostasis, in particular NSAIDs, during repeated punctures.
When combined with spinal or epidural anesthesia and enoxaparin, it is best to install and remove the catheter before administering enoxaparin. When performing spinal or epidural anesthesia, it is best to insert and remove the catheter when the anticoagulant effect of enoxaparin sodium is low: 10-12 hours after administration at a dose of 4000 anti-Xa IU/kg or less, or 24 hours after administration of the drug in high doses (100 anti-Xa IU/kg 2 times a day or 150 anti-Xa IU/kg once a day). The next administration of enoxaparin sodium should be carried out no earlier than 2 hours after removal of the catheter. Strict medical monitoring of the patient's neurological status is necessary. If signs of a spinal hematoma appear, appropriate treatment should be immediately prescribed (if necessary, spinal cord decompression).
Medical supervision is required when prescribing the drug to patients with a history of heparin-induced thrombocytopenia with or without thrombosis.
It is recommended to determine the platelet count before and throughout the course of treatment. If the platelet count decreases by 30-50% of the initial value, the drug should be discontinued immediately.
Enoxaparin sodium in doses used for the prevention of venous thromboembolism does not significantly affect bleeding time and other parameters of blood coagulation, including platelet aggregation or fibrinogen binding to platelets. When using the drug in higher doses, the aPTT and activated clot formation time may increase. However, the increase in these indicators does not directly depend on the increase in the antithrombotic activity of enoxaparin and does not require constant monitoring.

Drug interactions Clexane

Due to the increased risk of bleeding, Clexane should not be used simultaneously with acetylsalicylic acid and other NSAIDs in high doses, ticlopidine, clopidogrel, dextran 40, corticosteroids, thrombolytics, anticoagulants, and other antithrombotic drugs, including glycoprotein IIb/IIIa antagonists. If it is necessary to use such combinations, careful clinical and laboratory monitoring should be carried out, however, today there is experience in the safe combined use of enoxaparin sodium with the above drugs.

Clexane overdose, symptoms and treatment

As a specific antidote, slow intravenous administration of protamine sulfate (hydrochloride) is indicated at the rate of 1 mg of protamine per 1 mg of Clexane (if enoxaparin sodium was administered over the previous 8 hours). However, even with the introduction of protamine sulfate in a high dose, the effect of enoxaparin sodium is not completely neutralized (maximum - up to 60%). Since neutralization may be temporary (due to the absorption characteristics of low molecular weight heparins), the dose of protamine must be divided into several injections (from 2 to 4) over 24 hours.

Storage conditions for the drug Clexane

At a temperature not exceeding 25 °C. Do not freeze.

List of pharmacies where you can buy Clexane:

  • Saint Petersburg
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