From the Guidelines
Clexane, also known as enoxaparin, is a low molecular weight heparin that should be administered at a dose of 40mg once daily for deep vein thrombosis prevention, and 1mg/kg twice daily for treatment, as recommended by the most recent guidelines 1.
Key Points
- Clexane is used as an anticoagulant to prevent and treat blood clots, and its dosing is based on patient weight and indication.
- The treatment duration varies from days to weeks depending on the condition being treated.
- Patients should inject Clexane into the fatty tissue of the abdomen, alternating between left and right sides.
- Side effects include bleeding, bruising at injection sites, and rarely, thrombocytopenia.
- Regular blood tests may be needed to monitor platelet counts and kidney function.
Administration and Monitoring
- Clexane has a more predictable dose response than unfractionated heparin and typically doesn't require routine monitoring of clotting parameters.
- However, renal function should be taken into account when selecting the dose, as Clexane is eliminated by the kidney 2.
- The dose should be reduced to 1 mg/kg SC once daily in patients with significant renal dysfunction, defined as creatinine clearance of less than 30 mL/min 3.
Clinical Evidence
- The most recent guidelines recommend Clexane as the first-line pharmacologic agent for prophylaxis of venous thromboembolism 1.
- Studies have shown that Clexane is effective in reducing the risk of recurrent ischemic events and invasive diagnostic and therapeutic procedures in patients with non-ST-elevation acute coronary syndromes 3.
- Clexane has also been shown to be effective in preventing and treating blood clots in patients with cancer, with a recommended dose of 40mg once daily for prophylaxis and 1mg/kg twice daily for treatment 4, 1.
From the Research
Overview of Clexane
- Clexane, also known as enoxaparin, is a low molecular weight heparin (LMWH) used to prevent venous thromboembolism (VTE) in patients at risk 5, 6, 7.
- It works by binding to and increasing the activity of antithrombin III, which inhibits prothrombinase-mediated thrombin generation and direct thrombin generation by binding to factor Xa and thrombin factor IIa 7.
Efficacy and Safety
- Enoxaparin has been shown to be effective in preventing VTE in medical patients, with a significant reduction in the incidence of deep vein thrombosis and pulmonary embolism compared to placebo 7.
- It has also been compared to unfractionated heparin (UFH) and found to be at least as effective, with a similar safety profile 5, 7.
- A study comparing enoxaparin to fondaparinux found that enoxaparin was at least as effective and safe as fondaparinux in the initial treatment of patients with symptomatic deep venous thrombosis 6.
Administration and Dosage
- Enoxaparin is typically administered subcutaneously, with a recommended dose of 40 mg once daily for thromboprophylaxis in medical patients 5, 7.
- The optimal duration of prophylaxis is still being evaluated, but short-term enoxaparin appears to provide a cost-effective treatment alternative to UFH for VTE prophylaxis in nonsurgical patients 5.
Risks and Complications
- Missed doses of enoxaparin have been correlated with an increased incidence of deep vein thrombosis in trauma and general surgery patients 8.
- A study found that switching from enoxaparin to fondaparinux in thoracic surgery patients was associated with a significant increase in the risk of postoperative major bleeding 9.
- Common adverse events reported with enoxaparin include hemorrhage, hematoma at injection site, anemia, fever, peripheral edema, nausea, ecchymosis, and edema (unspecified site) 7.