Product Introduction:
Clexane (Enoxaparin Sodium) is indicated for the prophylaxis of deep vein thrombosis (DVT) in surgical and medical patients, the treatment of acute DVT (with or without pulmonary embolism), and in certain acute coronary syndromes. Its predictable pharmacokinetics allow for fixed dosing without routine monitoring in most patients.
Uses of Clexane 40 mg Injection:
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DVT Prophylaxis – In patients undergoing abdominal or orthopedic surgery.
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Treatment of DVT – With or without pulmonary embolism (PE).
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Acute Coronary Syndromes – Unstable angina and non‑ST elevation myocardial infarction (NSTEMI).
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ST‑Elevation Myocardial Infarction (STEMI) – In conjunction with thrombolytics or primary PCI.
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Percutaneous Coronary Intervention (PCI) – As adjunct anticoagulation.
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Hemodialysis – Prevention of clotting in extracorporeal circuits (off‑label).
Storage Instructions:
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Store at 2 °C to 8 °C (refrigerator) or at room temperature ≤25 °C.
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Do not freeze.
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Keep in original packaging to protect from light.
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Discard if solution is discolored or contains particulate matter.
How It Works (Mechanism of Action):
Enoxaparin binds to antithrombin III, accelerating inhibition of factor Xa and, to a lesser extent, factor IIa (thrombin). This prevents conversion of prothrombin to thrombin and ultimately fibrin formation, reducing clot propagation.
Side Effects:
Common:
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Injection‑site bruising, pain, erythema
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Minor bleeding (gingival, epistaxis)
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Elevated liver enzymes
Severe (Rare):
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Major hemorrhage (intracranial, gastrointestinal)
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Heparin‑induced thrombocytopenia (HIT)
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Allergic reactions (rash, urticaria)
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Hyperkalemia
Seek immediate medical attention for signs of serious bleeding or HIT.
Dosage (Typical Recommended Dose):
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DVT Prophylaxis (medical or surgical): 40 mg SC once daily
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Treatment of DVT/PE: 1 mg/kg SC every 12 hours or 1.5 mg/kg SC once daily
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Unstable Angina/NSTEMI: 1 mg/kg SC every 12 hours (with oral antiplatelets)
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STEMI (with thrombolysis): 30 mg IV bolus + 1 mg/kg SC, then 1 mg/kg SC every 12 hours
Adjust dose in renal impairment (CrCl <30 mL/min): 1 mg/kg SC once daily.
Method of Administration:
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Subcutaneous injection into the anterolateral or posterolateral abdominal wall.
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Rotate injection sites; do not aspirate or massage after injection.
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Use pre‑filled syringe and needle provided; dispose of sharps safely.
Precautions:
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Bleeding risk: Avoid in active bleeding, severe uncontrolled hypertension.
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Spinal/epidural hematoma: Increased risk with neuraxial anesthesia or puncture.
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Renal impairment: Dose adjustment required; monitor anti‑Xa if necessary.
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Elderly: May require dose reduction.
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Pregnancy: Category B; weigh risks/benefits.
Drug Interactions:
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Antiplatelet agents (aspirin, clopidogrel) – ↑ Bleeding risk
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Other anticoagulants (warfarin, dabigatran) – ↑ Bleeding risk
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NSAIDs – ↑ Bleeding risk
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Thrombolytics – ↑ Hemorrhage risk
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Glycoprotein IIb/IIIa inhibitors – ↑ Bleeding risk
Inform your healthcare provider of all concomitant medications.
Allergies (Warnings for Allergic Reactions):
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Contraindicated in hypersensitivity to enoxaparin, heparin, or pork products.
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Monitor for rash, pruritus, anaphylaxis during therapy.
Overdose Information:
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Symptoms: Uncontrolled bleeding, hematoma formation.
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Management: Protamine sulfate 1 mg per 1 mg enoxaparin (max 50 mg) IV slowly; supportive care and blood product replacement as needed.
Missed Dose Instructions:
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If <6 hours late, administer as soon as possible and continue schedule.
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If >6 hours late, skip missed dose and resume next scheduled injection.
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Do not double dose to compensate.
Additional Notes:
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Monitor platelet counts for HIT between days 5–14.
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Anti‑Xa levels rarely required; consider in obesity, pregnancy, pediatrics, renal impairment.
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Encourage mobility to reduce DVT risk.
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Educate patients on signs of bleeding and injection technique.
