Therapy monitoring

In contrast to a standard heparin, the fluctuations of the drug level in the body are significantly lower with low-molecular-weight heparin. For this reason, therapy monitoring is usually not absolutely necessary. Exceptions are patients who have an increased risk of bleeding and/or patients who suffer from renal insufficiency. In such cases, the determination of anti-Factor Xa activity can be performed to monitor therapy. The best time to determine anti-Factor Xa activity is 3-4 hours after the last administration of Mono-Embolex®.

Side effects

The most common adverse drug reaction of a low-molecular-weight heparin such as Mono-Embolex® is an increased tendency to bleed or a bleeding. Skin bleeding, nosebleeds, stomach bleeding or intestinal bleeding can occur. Even in such a situation, the effect of the antagonist protamine can only partially be counteracted.

The risk of a drop in the number of blood platelets (thrombocytes) in the blood, known in the technical jargon as thrombocytopenia, is significantly lower with the administration of a low-molecular-weight heparin than with the administration of a standard heparin. However, cases of thrombocytopenia have also been described with the use of short-chain heparin. If the drop in thrombocyte values occurs during heparin therapy, one speaks of heparin-induced thrombocytopenia, or HIT for short.

A warning signal is a drop in platelet values below 50% of the initial value. Other adverse drug reactions are allergic and anaphylactoid reactions (acute intolerance reactions), an increase in liver values (increase in the transaminases GOT and GPT), irritation and changes at the injection site and, rarely, hair loss. When used over a longer period of time, a decrease in bone density (osteoporosis) may occur.

Interactions

The effect of Mono-Embolex® can be enhanced by taking medication that also inhibits blood clotting. These include oral anticoagulants such as phenprocoumon (Marcumar®) or substances that inhibit the aggregation of blood platelets (platelet aggregation inhibitors) (for example acetylsalicylic acid, or ASA for short, clopidogrel or ticlopidine). Other drugs, such as non-steroidal anti-inflammatory drugs such as indomethacin and ibuprofen, can enhance the effect of Mono-Embolex® and thus lead to an increased bleeding tendency.

A weakening of the effect of Mono-Embolex® is caused by antihistamines, digitalis, vitamin C and nicotine. Mono-Embolex® can also enhance the effect of other substances. These include benzodiazepines, phenytoin, quinidine and propranolol.

This is due to the fact that certoparin, the active ingredient of Mono-Embolex®, displaces these substances from their binding to plasma proteins, so that a higher percentage of drugs are available in the free, active form. Mono Embolex® and alcohol do not have any direct interactions. The effect of Mono Embolex® therefore remains the same.

However, Mono Embolex® reduces blood clotting. This should be taken into account, as the influence of alcohol can lead to increased accidents. Furthermore, during an acute thrombosis, stress on the affected extremity should be avoided.