What is Clexane (enoxaparin)?

What is Clexane (Enoxaparin)?

Clexane (enoxaparin) is a low molecular weight heparin (LMWH) that acts primarily by inhibiting factor Xa and thrombin, providing more predictable anticoagulation than unfractionated heparin with fewer monitoring requirements. 1

Mechanism of Action

Enoxaparin is derived from unfractionated heparin but has several important advantages:

• Greater activity against Factor Xa than thrombin (4:1 ratio of Factor Xa to thrombin activity) 2
• Reduced binding to plasma proteins resulting in more predictable anticoagulant effect 2
• Longer half-life than unfractionated heparin 2
• High bioavailability and linear dose-response relationship 3

Clinical Applications

Clexane is widely used for:

1. Prevention of venous thromboembolism (VTE):

   • In surgical patients (particularly orthopedic, cancer, and vascular surgery) 3
   • In acutely ill medical patients with restricted mobility 4
   • In patients with multiple trauma 2

2. Treatment of existing deep vein thrombosis (DVT) and pulmonary embolism 5

3. Acute coronary syndromes:

   • Reduces death and serious cardiac events compared to unfractionated heparin 3
   • Used in combination with thrombolytic therapy 2

4. Anticoagulation during hemodialysis 5

Dosing Regimens

The dosing of Clexane varies based on indication:

• Prophylactic dosing:

  • Standard prophylaxis: 40 mg subcutaneously once daily 1
  • Severe renal insufficiency (CrCl <30 mL/min): 30 mg subcutaneously once daily 1
  • High-risk surgical patients: 30 mg subcutaneously twice daily 1
  • Class III obesity (BMI >40): 40 mg twice daily or 0.5 mg/kg twice daily 1

• Treatment dosing:

  • 1 mg/kg subcutaneously every 12 hours or 1.5 mg/kg once daily 1
  • For severe renal impairment: 1 mg/kg once daily 1

Advantages Over Unfractionated Heparin

• Does not require routine monitoring of aPTT 1
• Once or twice daily dosing versus multiple daily injections for unfractionated heparin 4
• Lower incidence of heparin-induced thrombocytopenia 2
• Lower incidence of local hematomas and increased liver enzymes 4
• Can be administered at home for outpatient treatment 3

Safety Considerations

• Bleeding risk: Major concern, especially when used perioperatively 6

  • Timing is important - fewer complications when first dose is given ≥10 hours postoperatively 6
  • Significantly increased postoperative bleeding compared to no anticoagulation 6

• Renal function: Clearance is reduced in renal impairment, requiring dose adjustment or alternative anticoagulants in severe renal dysfunction 1

• Special populations:

  • Elderly patients may require dose adjustment 1
  • Pregnant women may require dose adjustments based on anti-Xa levels 1
  • Morbidly obese patients may need weight-based dosing 1

Monitoring

• Routine monitoring of anti-Xa levels is not recommended for most patients 1
• Clinical monitoring for signs of bleeding or thrombosis is essential 1
• Renal function should be monitored at least yearly in stable patients 1
• Platelet count monitoring is recommended due to risk of heparin-induced thrombocytopenia 1

Efficacy

• In prevention of VTE in medical patients, enoxaparin 40 mg daily showed a significant reduction in VTE incidence (5.5%) compared to placebo (14.9%) 7
• Meta-analysis showed LMWH reduced venous thrombosis compared to unfractionated heparin (15.9% vs 21.7%) 2
• In multiple trauma patients, enoxaparin reduced thrombosis compared to low-dose heparin (31% vs 44%) 2

Clexane represents an important advancement in anticoagulation therapy with improved efficacy, safety profile, and convenience compared to traditional unfractionated heparin.