Clexane and fraxiparine which is better. Clexane during pregnancy - rules for safe use

Elena Volkova, Male, 42 years old

I have had thrombophlebitis for 14 years now. lower limbs, with damage to the deep veins. Complication in the form trophic ulcers lower leg and calf. I take warfarin 2 tablets 2 times a day. about a week, before that I took 1 tablet 2 times a day for another 2 weeks. The latest tests are INR 1.14; PTI 84. Previously, low molecular weight heparin was prescribed in another city, but in their own city, doctors had not even heard that such drugs were used. I would like to know how to calculate the dose and which drug is more effective. My weight is 105-110 kg. Drugs Clexane or Fraxiparine. Maybe something else is possible. I just found these. Or rather, you can only order these at the pharmacy. CLEXANE SOLUTION FOR INJECTION 8000 ANTI-HA IU / 0.8 ML. SYRINGES No. 10 FRAXIPARINE SOLUTION P-K 9500 ANTI-HA ME / ML 0.8 ML. SYRINGES No. 10

Good afternoon You took it in vain, because your INR values ​​should be between 2-3, otherwise it is ineffective and meaningless. You can replace it with Pradaxa or (!they are taken in standard dosages and do not require laboratory monitoring) As for Clexane and Fraxiparine, they are not convenient in terms of the method of administration. Don’t forget about high-quality compression hosiery if you have a problem. Sincerely, vascular doctor Evgeniy Aleksandrovich Goncharov

Consultation with a phlebologist on the topic “I have thrombophlebitis, I want to inject Clexane or Fraxiparine” is given for informational purposes only. Based on the results of the consultation received, please consult a doctor, including to identify possible contraindications.

About the consultant

Details

Cardiovascular surgeon (phlebologist), general surgeon, ultrasound diagnostics doctor.

Member of the Russian Society of Angiologists and Vascular Surgeons, member of the European Society of Vascular Surgeons, member of the International Society of Lymphology (ISL)

Education:

• VSMA named after. N.N. Burdenko with a degree in general medicine
• Clinical residency at MMA named after. I.M. Sechenov, specialty "surgery"
• Clinical residency at the National Medical Center named after. N.I. Pirogov specialty " cardiovascular surgery",
• Professional retraining specialty "ultrasound diagnostics"

Area of ​​professional interests: all types of operational and conservative treatment diseases of arteries and veins: obliterating atherosclerosis arteries of the lower extremities with critical ischemia and diabetes mellitus, vascular malformations and congenital angiodysplasias, stenosing atherosclerosis of the brachiocephalic arteries, aneurysms abdominal region aorta and arteries of the extremities, nonspecific aortoarteritis and thromboangiitis, Raynaud's disease and syndrome, varicose veins of the lower extremities, thrombosis and thrombophlebitis of the veins of the upper and lower extremities, lymphedema (elephantiasis), trophic ulcers, varicose veins of the small pelvis (pelvic venous congestion syndrome) and etc., endolymphatic methods of treating diseases.

At increased viscosity blood anticoagulants are used to prevent blood clots. These drugs have various compositions and mechanisms of action. Patients often have a question about what to choose, Fraxiparine or Clexane. An analysis of the characteristics of two anticoagulants will help you understand which medicine is suitable in a given situation.

Characteristics of Clexane

The medicine has the following characteristics:

1. Release form and composition. Clexane is available as a solution for injection, which is a colorless clear liquid. The drug is packaged in glass syringes with a volume of 0.2 ml. Each syringe contains 20, 40, 60, 80 or 100 mg of enoxaparin sodium and water for injection. Ampoules are supplied in plastic cells of 2 pieces.
2. Pharmachologic effect. Enoxaparin sodium acts on factor Xa, preventing the conversion of prothrombin to thrombin. Other activities identified active substance- suppression of the production of inflammatory mediators and improvement of the condition vascular walls. The drug activates the production of tissue factor inhibitor and reduces the rate of release of von Willebrand factor from the vascular lining. These actions provide high anticoagulant activity of Clexane. The use of the drug helps reduce prothrombin time and platelet aggregation rate.
3. Absorption, distribution and excretion. The anticoagulant effect of the drug develops 3-5 hours after administration. In the liver, enoxaparin sodium is converted into low molecular weight metabolites with low pharmacological activity. Half-life active ingredient takes 5 hours. Enoxaparin and its metabolites leave the body in the urine.
4. Indications for use. Clexane is used in the prevention and treatment of deep vein thrombosis in patients with moderate and high risk. Indications for the administration of the drug are: recovery after orthopedic and general surgical interventions, thrombosis in persons observing bed rest, thromboembolism pulmonary arteries. Clexane can be used to prevent blood clots in the artificial circulation system during hemodialysis. The drug reduces the risk fatal outcome with myocardial infarction and unstable angina.
5. Contraindications. Clexane should not be administered if you have an allergic reaction to enoxaparin, internal bleeding, hemorrhagic stroke, exacerbation of stomach ulcers, previous surgical interventions in spinal cord, varicose veins veins of the esophagus. The drug should be used with caution in cases of bleeding disorders, erosive and ulcerative lesions Gastrointestinal tract in remission, stroke, recovery after childbirth, diabetes mellitus 2 types. The safety of the drug for children has not been confirmed, so it is not prescribed to patients under 18 years of age.
6. Mode of application. The drug is administered subcutaneously. The dosage is determined by the type of disease and general condition body. For thrombophilia, 20 mg of enoxaparin per day is administered. In order to prevent postoperative thrombosis, the first injection of Clexane is given 2 hours before the intervention. The course of treatment lasts 10 days, if necessary it is continued until blood clotting time normalizes.
7. Drug interactions. Clexane should not be used in combination with non-steroidal anti-inflammatory drugs, thrombolytics, acetylsalicylic acid. The anticoagulant is used with caution in combination with clopidogrel, ticlopidine and dextran. When using Clexane in combination with calcium supplements, regular blood and urine tests are required.
8. Side effects. The use of high doses of the drug may contribute to the development of internal bleeding, accompanied by a decrease in blood pressure, pallor skin, muscle weakness. During treatment there may be allergic reactions as skin itching, urticaria, swelling of the face and larynx. When Clexane is administered subcutaneously, hematomas and infiltrates may form.

Characteristics of Fraxiparine

Fraxiparine has the following qualities:

1. Release form and composition. The anticoagulant is available in the form of a solution for subcutaneous administration. It is a transparent, light yellow, odorless liquid. The drug is supplied in disposable glass syringes with a volume of 0.4 ml. Each syringe contains 3800, 5700 or 7600 IU of anti-Xa nadroparin calcium, calcium hydroxide, diluted hydrochloric acid.
2. Pharmachologic effect. Nadroparin calcium binds to the plasma component antithrombin, helping to reduce the activity of factor Xa. This explains the high antithrombotic activity of the active substance. Compared with heparin, nadroparin has a less pronounced effect on platelet aggregation and primary hemostasis. When used in moderate doses, Fraxiparine does not reduce prothrombin time. When used as a course, the drug acquires a prolonged effect.
3. Pharmacokinetics. When administered subcutaneously, maximum antithrombotic activity develops after 3-4 hours. Nadroparin is absorbed almost completely. At intravenous administration Fraxiparine takes effect within 10 minutes. In the liver, nadroparin is converted into inactive metabolites, which are excreted by the kidneys. The half-life is 3.5 hours.
4. Indications for use. The drug is used to prevent thromboembolism during surgery, cardiac and respiratory failure. The administration of Fraxiparine during hemodialysis prevents blood clotting. An anticoagulant is included in the regimen complex treatment myocardial infarction and unstable angina. The medicine can be used when planning pregnancy in women suffering from thrombophilia.
5. Contraindications. The drug is not used for thrombocytopenia caused by the use of heparin-based anticoagulants, internal bleeding, hemorrhagic syndrome, intracranial hemorrhage, severe renal failure, acute bacterial endocarditis. The drug is not prescribed to children and adolescents under 18 years of age. Fraxiparine should be administered with caution for liver diseases, hypertension, peptic ulcers, exhaustion of the body. When treating diabetes, the condition of the fundus vessels should be monitored.
6. Mode of application. The drug is administered in a lying position in subcutaneous tissue anterior abdominal wall. Before using Fraxiparine, there is no need to remove air bubbles from the syringe. The needle is inserted at a right angle into the clamped skin fold. There is no need to rub the injection site.
7. Drug interactions. When used in combination with ACE inhibitors, diuretics and potassium salts may develop hyperkalemia. Concomitant use with antiplatelet agents increases the risk of bleeding. Fraxiparine should be prescribed with caution to patients taking glucocorticosteroids.
8. Side effects. The most common side effect of treatment is bleeding various localizations, decreased platelet count and allergic reactions. A rare side effect is tissue necrosis at the injection site, which is preceded by the formation of an infiltrate.

Comparison of drugs

Anticoagulants have both common and distinctive characteristics.

Similarities

The similarities between Clexane and Fraxiparine are the following characteristics:

• type of active substance (both enoxaparin and nadroparin are low molecular weight heparins);
• general indications for use;
• Possibility of use during planning and management of pregnancy;
• release form (both drugs are available in the form of a solution for subcutaneous administration);
• general contraindications and side effects.

Differences

The difference between the drugs lies in the amount and activity of the active substance.

What's stronger?

Clexane has a more pronounced antithrombic effect than Fraxiparine.

Which is cheaper?

Clexane has a higher price than Fraxiparine.

Is it possible to replace Clexane with Fraxiparine?

Fraxiparine has a less pronounced pharmachologic effect, therefore the drug is not always able to replace the more effective Clexane.

Which is better: Fraxiparine or Clexane?

It is difficult to answer the question of which injections are more effective. When prescribing medications, the doctor takes into account individual characteristics body.

During pregnancy

Fraxiparine causes less side effects, therefore it is the drug of choice for thrombophilia in pregnant women. If this medicine is ineffective, Clexane is prescribed.

Doctors' opinion

Sergey, 44 years old, Moscow, hematologist: “Clexane and Fraxiparine are used to reduce blood clotting. This helps prevent the development of deep vein thrombosis and blockage of the pulmonary arteries in patients forced to remain in bed. Fraxiparine is more safe drug, it is approved for use during pregnancy and lactation. Clexane can cause a number of negative consequences, therefore should be used under constant control doctor."

Tatyana, 55 years old, Tolyatti, gynecologist: “Clexane and Fraxiparine are often prescribed during pregnancy planning. The drugs are different high efficiency and ease of use. I consider the disadvantage of both drugs to be the need for injection into the anterior abdominal wall, which causes strong painful sensations. Because Fraxiparine is better tolerated by the body, it is prescribed after pregnancy.”

Not every woman has to take medications that reduce blood clotting during pregnancy. If such a need arises, doctors often give preference to Clexane. However, the medicine has some contraindications and may cause side effects.

Action and safety of the drug Clexane

Clexane belongs to the group of anticoagulants direct action, is used to improve rheological parameters (changes in viscosity) of blood. The pharmaceutical industry produces remedy in the form of disposable glass syringes with pale yellow or transparent color various dosages.

The main active ingredient of Clexan is enoxaparin sodium, and water acts as an auxiliary component. The bioavailability of the drug when administered subcutaneously is achieved 100%. This means that the medicine is completely absorbed.

Clexane is a direct anticoagulant that affects blood clotting

The drug activates antithrombin III (a specific protein of the body), thereby inhibiting the formation blood clots. Thanks to the antithrombic effect of the drug, blood clotting is reduced and its viscosity is normalized.

There is no information in the instructions that Clexane should not be used during pregnancy. However, it is indicated that the drug is prescribed only when there are appropriate indications for this, established by a hematologist or gynecologist.

Clexane has proven itself well in clinical practice, doctors’ opinions about the drug are quite positive. However, there are other views. The fact is that during pregnancy, the hypercoagulation process (blood thickening, which is associated with preparation for childbirth) is the norm. Therefore in most cases to the expectant mother It is not necessary to use thrombolytic agents.

For women with a high tendency to develop blood clots, Clexane is recommended as a prophylaxis along with other methods, since the likelihood of blood clots in them is 50% (moreover, in 90% of cases, thromboembolic complications develop after childbirth). When using the medicine in for preventive purposes There was no trend towards an increase in the occurrence of bleeding.

Indications

The main indications for prescribing Clexane during pregnancy are:

• deep vein thrombosis;
• development of hypercoagulability syndrome ( increased coagulability blood);
• unstable angina;
• heart failure;
• predisposition to thrombosis.

A pregnant woman is prescribed the drug only in II and III trimesters. It has not yet been studied how the medicine affects the development of the embryo, therefore in the first 12 weeks, when the baby’s organs and systems are formed, it is not prescribed.

The American Food and Drug Administration has classified Clexane as category B. This means that experiments conducted on animals did not reveal any negative effects on the fetus. However, adequate and full research have not been conducted on pregnant women. Therefore, a doctor can prescribe a drug only if there is a real need for its use.

Contraindications, side effects and other dangers associated with the use of Clexane

Clexane is contraindicated for use in:

• intolerance to the main active ingredient and other heparins;
• the threat of bleeding or spontaneous abortion;
• stomach or duodenal ulcer in the active phase;
• severe renal failure;
• arterial hypertension (persistent increase in blood pressure);
• undergone or planned surgery;
• diabetes;
• increased body weight.

When prescribing the drug, the doctor takes into account the interaction with other medications, since some combinations of them contribute to the development of negative consequences for the body of a pregnant woman. Combinations with:

• acetylsalicylic acid;
• anti-inflammatory non-steroidal drugs. These can be antipyretic, painkillers (Ibuprofen, Diclofenac, Ketorolac);
• thrombolytics, which help destroy the blood clot, since the risks of bleeding increase (Eminase, Plasmin);
• anticoagulants - anticoagulants (Heparin, Heparin ointment);
• systemic glucocorticosteroids - hormonal antiallergic drugs (Prednisolone, Dexamethasone).

If Clexane is used with these drugs, the risk of bleeding increases.

Treatment with Clexane is sometimes accompanied by the appearance side effects:

• pain and bruising at the injection site;
• nausea;
• allergic manifestations;
• bleeding;
• osteoporosis (with long-term use);
• thrombocytopenia (decreased levels of red blood cells. May cause massive bleeding and lead to death of the woman and fetus);
• hemorrhagic syndrome (a condition of increased bleeding associated with disturbances in one of the links of the blood coagulation system).

Bruising may occur after Clexane injections.

Side effects usually occur when recommendations are not followed (exceeding the dosage, unreasonably long therapy, lack of weight adjustment, interaction with other medicines). A pregnant woman should strictly follow the doctor's instructions and not self-medicate, as this may lead to premature birth, spontaneous abortion and other undesirable consequences.

Overdose is possible if the medicine is administered subcutaneously or intravenously in large doses. In this case, serious hemorrhagic complications- bleeding, disturbance heart rate, a sharp decline blood pressure. Such conditions require urgent medical intervention.

Rules for using the drug

The dosage and duration of therapy is determined depending on the complexity of the disease, the age of the pregnant woman and her weight. The medicine is taken only as prescribed by a doctor and under his strict supervision. The course of treatment can be 2–10 days, if necessary it is continued.

The drug Clexane is produced complete with disposable syringe ampoules

Administration technique

Injections are administered only subcutaneously in the abdominal area.

1. Before performing the procedure, the woman lies down on the couch.
2. The injection is made to the left or right of the navel.
3. At the selected location, the skin is gathered into a fold and a syringe is inserted into it strictly perpendicularly to its entire depth.
4. After the product has been completely introduced, the skin fold is released.

Please note that the injection site should not be massaged or scratched.

Clexane injections are given to pregnant women by experienced nurses in a hospital setting

Injections are strictly prohibited from being administered intramuscularly. Together with the drug Clexane, the doctor usually prescribes Curantil or Dipyridamole tablets (to improve placental blood flow, normalize venous outflow, and also eliminate fetal hypoxia).

It is not recommended to stop manipulations abruptly. Doctors advise to gradually reduce the dosage of the medicine and stop giving injections 2-3 days before giving birth (before caesarean section- per day). This is done to avoid bleeding problems. After delivery, injections into the minimum dosage, to prevent the formation of blood clots.

Analogues of the drug

Clexane belongs to the group of low molecular weight heparins, so there is no complete analogue to the product. All drugs differ in molecular weight, composition and effect on the body of a pregnant woman.

Replacing the drug Clexane with another medicine possible in case of side effects or other undesirable manifestations.

Table - drugs to prevent blood clots allowed for pregnant women

Sometimes it happens that married couple It is very difficult to give birth to a baby. For this reason they are forced to use alternative ways conception. But in this case, it will be necessary to support the mother’s body with medication, because before IVF she takes hormonal treatment. Since a pregnant woman’s blood thickens, this is fraught with consequences not only for her, but also for the blood circulation of the fetus. Therefore, she is prescribed anticoagulants. But what better than Clexane or Fraxiparine - the following information will help you figure it out.

Indications and contraindications

In most cases, doctors prescribe Flexan or Fraxiparine. The drugs are basically equivalent, the difference between Fraxiparine and Clexane is the amount of active ingredient in one dose. Clexane is half as strong as Fraxiparine.

After all, as you know, a pregnant woman’s blood thickens greatly, warning the body against heavy blood loss during childbirth. But with IVF, indicators above the norm are generally unacceptable, because of this, cell mutations are possible.

Clexane and Fraxiparine are prescribed to many pregnant women, but not everyone knows why the injections are given. Both medications help prevent blood clots.

Why is Clexanpri IVF prescribed:

1. for blood thinning;
2. prevention of thrombosis;
3. to avoid cell mutation due to constant surgical interventions in the body;
4. restoration of normal blood flow to the fetus.

Clexane during IVF will help get rid of blood problems. It is important that before starting to use the drug, it is better to consult a hematologist, because a woman’s body can not only be cured, but also suffer from the medicine.

• are allergic to heparin and derivatives;
• there is a risk of spontaneous abortion;
• there is a history of diseases accompanied by bleeding.

It is worth noting that the drug cannot be used together with acetylsalicylic acid and medications that contain it.

For achievement best result from injections, you need to follow the recommendations for their use.

Which is better hemapaxan or fraxiparin? Although they are classified as anticoagulants, active substance they are different, and there is no need to compare them.

To achieve maximum effect, you need to inject correctly.

Introduction rules:

• lie on your back;
• do not release air from the syringe;
• disinfect the intended injection site on the stomach;
• gather the skin of the abdomen into a fold;
• medications should be administered subcutaneously;
• It is recommended to release the skin after the injection;
• do not knead the injection site;
• inject into different parts of the abdomen alternately.

The medicine is in disposable syringes, which have already been processed and are sterile.