Definition
When people talk about “Clexane 40®”, they usually mean a pre-filled heparin syringe containing 4000 IU (international units). This corresponds to 40 mg enoxaparin sodium of the active ingredient enoxaparin . “Clexane 40®” is the trade name of this drug. The drug is dissolved in a defined volume of 0.4ml. In addition to this dosage there are other dosages available (e.g. Clexane 20® = 2000IE in 0.2ml; Clexane 80® = 8000IE in 0.8ml).
Mode of operation
The active ingredient enoxaparin is a low-molecular-weight heparin. All low-molecular-weight heparins interfere with and inhibit natural blood coagulation by enhancing the effect of the body’s own coagulation factor (factor Xa). These are called low-molecular heparins because they are chemically very small molecules (consisting of approx.
15 sugar units). In addition to enoxaparin, the active ingredient in “Clexane 40®”, other substances that are included are certoparin, dalteparin, nadroparin, reviparin and tinzaparin. The unfractionated heparins and fondaparinux also have similar effects and therefore belong to the large group of heparins.
Indications
“Clexane 40®” is prescribed by:
- Thrombosis prophylaxis, especially in the context of immobilization before, during and after operations
- Thrombosis therapy: if a thrombosis (especially of the leg and pelvic veins) is present, Clexane® is used to treat it
- Pulmonary embolism: Clexane® is also used in the therapy of pulmonary embolism
- Patients with long-term anticoagulant therapy (e.g. Marcumar, Xarelto®) for certain diseases (e.g. atrial fibrillation, artificial heart valves): for bridging therapy before surgery, these drugs must be replaced by higher-dose heparins (up to twice Clexane 80®).
Dosage
Enoxaparin should be dosed in a weight-adapted manner. The dosage also depends on the desired level of anticoagulation. For thrombosis prophylaxis in the context of operations on the musculoskeletal system (especially hips, legs) and for prophylaxis in the case of other non-surgical diseases that lead to immobility, “Clexane 40®” is usually prescribed, i.e. a dosage of 4000IE/day.
If kidney function is restricted, the dose of Clexane® must be adjusted. Otherwise the drug may accumulate in the blood. On the day of an operation “Clexane 40®” should not be given until 12 hours after the operation, so the risk of bleeding during the operation or for post-operative bleeding is not significantly increased.
The effect can be monitored by determining the factor Xa activity. However, this is not done routinely. This determination is sometimes used in children, pregnant women and patients with impaired kidney function.
Method of application
As already mentioned, “Clexane 40®” is available as a ready-to-use syringe and can therefore be administered by the patient himself or his relatives. Low molecular weight heparins should be applied subcutaneously (i.e. directly into the subcutaneous fatty tissue). The abdominal wall is best suited for this.
After disinfecting the injection site, a small skin fold is taken between two fingers and the needle is inserted vertically into this skin fold up to the end. Then the medication can be applied slowly. The needle can then be pulled out again.
