From the Guidelines
Clexane is a brand name for enoxaparin, a low molecular weight heparin medication used to prevent and treat blood clots, as supported by the most recent evidence from 1.
Overview of Clexane
Clexane works by inhibiting factor Xa and thrombin in the blood clotting cascade, which prevents clot formation. It is typically administered as a subcutaneous injection, with dosages ranging from 20mg to 150mg depending on the specific condition being treated and patient factors like weight and kidney function.
Common Uses and Side Effects
Common uses of Clexane include:
- Prevention of deep vein thrombosis after surgery
- Treatment of existing blood clots
- Prevention of clots during hemodialysis
- Management of acute coronary syndromes Side effects may include:
- Bleeding
- Bruising at injection sites
- Rarely, a condition called heparin-induced thrombocytopenia Patients using Clexane should be monitored for signs of unusual bleeding and should inform healthcare providers about all medications they take, as some drugs can increase bleeding risk when combined with enoxaparin.
Monitoring and Special Considerations
Unlike standard heparin, Clexane typically doesn't require routine blood monitoring for most patients. However, special considerations are needed for patients with renal insufficiency, as supported by evidence from 1. For example, enoxaparin is associated with a 2- to 3-fold increased risk of bleeding when administered in standard, unadjusted therapeutic doses to patients with severe renal insufficiency. Therefore, dose reductions are recommended for patients with creatinine clearance less than 30 mL/min.
Key Recommendations
The most recent and highest quality study 1 recommends the use of dalteparin over enoxaparin for the treatment of venous thromboembolism in patients with cancer, due to its higher efficacy and safety profile. However, enoxaparin is still a viable option, especially in patients with severe renal insufficiency, where specific dosing recommendations are available. Overall, the choice of low molecular weight heparin should be individualized based on patient factors and clinical circumstances.
From the Research
Definition of Clexane
- Clexane is another name for Enoxaparin, a low molecular weight heparin (LMWH) used to prevent venous thromboembolism (VTE) in surgical and nonsurgical patients 2, 3, 4, 5.
Mechanism of Action
- Enoxaparin binds to and increases the activity of antithrombin III, inhibiting prothrombinase-mediated thrombin generation and direct thrombin generation by binding to factor Xa and thrombin factor IIa 4.
Clinical Applications
- Enoxaparin is used as prophylaxis in medically ill patients at increased risk for thromboembolism, and has shown significantly increased efficacy compared with placebo in reducing the incidence of deep vein thrombosis and pulmonary embolism 4.
- It is also used in the treatment of acute coronary syndromes, with similar efficacy and safety in the prevention and treatment of venous thromboembolism 5.
Administration and Dosage
- Enoxaparin can be administered subcutaneously once-daily, with doses ranging from 20-60 mg/day, depending on the patient population and indication 3, 6.
Efficacy and Safety
- Enoxaparin has been shown to be at least as effective as unfractionated heparin in reducing the frequency of venous thromboembolism, with a similar safety profile 2, 6.
- The most frequent adverse events reported with enoxaparin include hemorrhage, hematoma at injection site, anemia, fever, peripheral edema, nausea, ecchymosis, and edema (unspecified site) 4.