Clexane® is the trade name of a drug with the active ingredient enoxaparin. This belongs to the group of low-molecular-weight heparins and is intended to inhibit blood coagulation by inhibiting the activity of a coagulation factor (factor Xa). Clexane® is used for the prophylaxis of thromboses, the treatment of thrombosis and pulmonary embolism and for anticoagulation in other indications (e.g. atrial fibrillation).
Clexane® is usually prescribed in a dosage of 0.4 ml for thrombosis prophylaxis before and after operations. The pre-filled syringe can be applied under the skin by the patient himself. A dreaded side effect is bleeding.
In addition, the blood platelets may drop. In general, with all medicines during pregnancy, it should always be considered together with the gynaecologist whether these medicines are absolutely necessary and whether they have any effects on the unborn child. If this is the case, an attempt should be made to replace the medication with a better tolerated preparation. It should also be noted that most medications have not been tested on pregnant women, so there is always some uncertainty about the safety of most medications during pregnancy. Nevertheless, there are databases on retrospectively observed side effects of drugs in pregnant women.
Use of Clexane® during pregnancy
In summary, Clexane® and other low molecular weight heparins are well tolerated during pregnancy and do not show any undesirable side effects. There are only a few good studies available on Clexane® pregnancy, however, it can be assumed from animal studies that the substance does not pass on to the unborn child, this is especially true from the 13th week of pregnancy. However, if pregnancy exists, the indication for anticoagulant therapy with Clexane® should be very narrowly defined.
Clexane® is used during pregnancy for the following indications: Epidural anaesthesia for pain therapy of pregnant women during childbirth must not be used under therapy with Clexane 40® as the risk of bleeding into the spinal canal with constriction of the spinal cord is increased. Even in the case of a possible caesarean section, this should not be carried out under therapy with Clexane 40®. In this case it is recommended to at least discontinue the dose on the day of the surgical delivery. The next dose should also be administered no earlier than 12 hours after the operation. – Treatment of thromboses during pregnancy
- Application for artificial heart valves (note: Marcumar for blood thinning is absolutely contraindicated during pregnancy)
- Prevention of birth complications with known coagulation disorders
What dosage do I need: 20, 40 or more mg?
The dosage of Clexane® during pregnancy depends on individual circumstances. As far as possible we try to prevent any medication during pregnancy. If this is not possible, the dose level is adjusted according to necessity and possibility.
The motto here is: as high as necessary and as low as possible. The recommended dose level of Clexane® can change during pregnancy. Regular blood tests can determine how much of the active ingredient is necessary.
Especially if the pregnant woman can or may for various reasons exercise less, a higher dosage may be necessary. Often a dose adjustment is indicated at the end of the pregnancy. In some cases a very high dose of 80 mg may be advisable.
It is also important to skip Clexane® towards delivery. This means that in case of a planned caesarean section the last injection with the active substance should be given at least 12 hours before the operation. If an unplanned Caesarean section is to be performed, the procedure is based on the obstetric situation and the last administration of Clexane®.
In patients at high risk of thrombosis or who are receiving high-dose prophylaxis, a switch to so-called unfractionated heparin may be advisable. In these cases, a change of the active substance is recommended in the 36th week of pregnancy or at the latest when the contractions have started regularly. The last unfractionated heparin is given 4 hours before the birth.
As a rule, Clexane® is resumed 6-12 hours after birth in an individual dosage. If spinal anaesthesia is desired at delivery, the last dose of Clexane® must be administered 10-12 hours prior to delivery. A new administration should be made 2-4 hours later in an adjusted dosage.
