Introduction
Mono-Embolex® is a so-called anticoagulant, i.e. a drug that inhibits blood coagulation (anticoagulant) and is thus used primarily for the prophylaxis and therapy of venous thrombosis and pulmonary embolism. The active ingredient of the preparation Mono-Embolex® is certoparin sodium. The active ingredient Certoparin belongs to the class of low molecular weight (=fractionated) heparins. These low-molecular-weight heparins can be obtained by separation (“fractionation”) of standard heparin (unfractionated heparin). Compared to standard heparin, they are shorter-chain and have a lower molecular mass.
Mode of action
Mono-Embolex® is a low-molecular-weight (=fractionated) heparin that inhibits certain sections of the coagulation cascade and thus the formation of a blood clot. This effect is due to the activation of the body’s own glycoprotein, i.e. a protein with one or more carbohydrate groups. This glycoprotein is called antithrombin III and inhibits factors in the coagulation cascade.
By inhibiting these clotting factors, the cascade that normally ultimately causes the formation of a blood clot is disrupted and the formation of the blood clot is prevented. Antithrombin III inhibits the activity of the factors even without the presence of Mono-Embolex®, but this reaction is usually very slow. After application of a heparin, such as Mono-Embolex®, the reaction is greatly accelerated.
Low molecular weight heparins primarily inhibit activated coagulation factor X (10) (so-called Stuart Prower factor) by activating antithrombin III, since only antithrombin III is sufficient to inhibit activated coagulation factor X. This inhibition is dose-dependent, i.e. the more heparin, the more inhibition. For the inhibition of other coagulation factors, such as activated coagulation factor II, also known as thrombin, the activation of antithrombin III is not sufficient.
Due to its size, a standard heparin is able to bind directly to a coagulation factor in addition to antithrombin III. Thus, a standard heparin can inhibit the activated coagulation factor X (Stuart-Prower factor) as well as the activated factor II (thrombin). In low-molecular-weight heparin, activated coagulation factor II is also inhibited to a small extent, but the inhibition of activated coagulation factor X is two to four times stronger than the inhibition of activated coagulation factor II. In summary, the active ingredient of Mono-Embolex® prevents the formation of a blood clot and, if a blood clot is already present, further growth is inhibited and dissolution is promoted.
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