home Endocrinology Why is Clexane prescribed during pregnancy? Clexane during pregnancy - rules for safe use

Why is Clexane prescribed during pregnancy? Clexane during pregnancy - rules for safe use

To prevent thrombosis, vascular accidents and other cardiovascular problems, Clexane injections are prescribed. The drug belongs to the group of low molecular weight heparins, has multiple contraindications, and should be used only under the supervision of a physician.

Composition and release form

Clexane is produced in the form of injection solutions: a completely clear to pale yellow liquid in glass syringes. One cardboard package contains from 1 to 5 blisters of 2 syringes each. Official international name Clexane – Enoxaparin, Latin name – clexane.

The solution contains water for injection as an auxiliary component. Active active substance low molecular weight sodium enoxaparin acts. The dosage of 1 syringe is measured in international units of anti-CA ME and is:

Syringe volume	Dose of anti-CA ME

Properties of the drug components

The drug belongs to the group of low molecular weight anticoagulants of the heparin class. Clexane has high anti-Xa activity and a relatively low ability to inhibit thrombin. Mechanism pharmacological action The drug consists of activating the protein antithrombin, which slows down the activity of factor X, without having a significant effect on platelet synthesis.

Under the influence of enoxaparin, APTT (activated partial thromboplastin time - the period during which a blood clot forms after calcium chloride or other reagents are added to it) may slightly change. Bioavailability of the active component at subcutaneous method administration is 100%. Enoxaparin is completely metabolized by the liver and 40% is excreted by the kidneys. The half-life is 4 hours (with single use) and 7 hours (with repeated administration).

Why is Clexane prescribed?

The drug is used for treatment and prevention cardiovascular diseases. According to the instructions, the main indications for prescribing injections are:

prevention of venous embolism or thrombosis after surgical intervention;
treatment of deep vein thrombosis uncomplicated by pulmonary embolism;
prevention of thrombosis in patients who for a long time forced to remain in bed - heart failure, severe infections, respiratory failure, rheumatic diseases;
treatment of angina pectoris;
therapy for myocardial infarction without Q waves;
treatment of acute infarction in individuals with ST segment enlargement.

How to inject Clexane

Instructions for use of the drug indicate that the solution must be injected deeply subcutaneously into the left or right side of the abdomen when the patient is in supine position. After the injection, it is not recommended to massage or rub the injection site. The dosage regimen and frequency of injection depend on the diagnosis:

	Dosage	Frequency of administration	Duration of treatment
Treatment of deep vein thrombosis	1.5 mg per 1 kg of patient’s body weight	1 time/day
Prevention of thrombosis, embolism		1 time/day
Patients at average risk of blood clots		1 time/day
Patients at high risk of blood clots		1-2 times/day

special instructions

Clexane is prohibited from being administered intramuscularly to pregnant and lactating women and children. In addition, the instructions contain the following instructions regarding treatment:

In case of a feeling of numbness or tingling of the extremities, disturbance of tactile sensations, intestinal upset or dysfunction Bladder, you should stop using Clexane and consult a doctor immediately.
The drug does not have a significant effect on human psychomotor abilities. Driving a car or taking part in work with increased concentration is possible throughout the course of therapy.
If the dosages and frequency of use specified in the instructions are followed, the drug does not affect platelet synthesis and hematopoiesis time.
During therapy, it is necessary to regularly take blood tests to monitor and detect possible bleeding in time.
Starting from days 15 to 21 of therapy, the patient's chance of developing thrombocytopenia (a condition characterized by a decrease in the number of platelets) increases. If treatment was prescribed for more than 10 days, it is necessary to monitor blood counts and compare them with the initial data laboratory examination.
Patients with liver, kidney problems, and elderly people should consult a doctor to adjust the treatment regimen.

Drug interactions

The instructions for use of Clexan warn that the drug is strictly prohibited from combining or alternating with other low molecular weight heparins. During treatment, it is important to consider the following abilities of the injection solution to interact with other medications:

The therapeutic effect of enoxaparin increases when combined with acetylsalicylic acid, warfarin derivatives, clopidogrel, dipyridamole, fibrinolytics ticlopidine.
Plasma substitutes, gout medications, loop diuretics and penicillins increase the effectiveness of Clexane.
The simultaneous use of low molecular weight heparins and nonsteroidal anti-inflammatory drugs (NSAIDs) increases the risk of hemorrhage (bleeding).
Antihistamines, cardiac glycosides, smoking, tetracycline antibiotics reduce the effectiveness of Clexane.
Concomitant use of low molecular weight heparins and anticonvulsants, antiarrhythmic medications or beta blockers leads to a decrease in the effectiveness of the latter.

Clexane and alcohol

The simultaneous use of the solution with alcohol or alcohol-containing drinks is strictly prohibited. Ignoring this instruction may result in increased side effects, liver failure, hemorrhagic apoplexy (sudden paralysis caused by ruptured arteries and bleeding in the brain).

Side effects

Clexane increases the risk of bleeding, especially when simultaneous administration other drugs that affect hemostasis. If blood flow disturbances are detected, you must immediately stop taking the medication. Other side effects of Clexane include:

Organ or system
		Headache.
Hematopoiesis	Hematoma, nose bleed, thrombocytopenia.	Intracranial hemorrhages, retroperitoneal hemorrhages.
Immune	Allergy (erythema, itching).	Anaphylactic shock.
Liver and bile ducts	Increased activity of transaminases (liver enzymes).	Cholestatic liver damage.
Musculoskeletal		Osteoporosis (when taking the drug for longer than 3 months).
Leather and soft subcutaneous tissue	Inflammation, swelling at the injection site, hardening of soft tissues.	Skin necrosis.

Overdose

Cases of drug overdose are extremely rare. Clinically, this manifests itself in increased side effects and an increased risk of bleeding. In case of overdose, the patient is advised to slowly administer a neutralizing substance - protamine sulfate. One milligram this drug completely inhibits the effect of 1 mg enoxaparin. Administration of protamine sulfate is not required if more than 12 hours have passed since the onset of the overdose.

Contraindications

Clexane is used only according to the instructions and under the supervision of a doctor. The medicine has a number of categorical contraindications that should be taken into account before starting treatment. These include:

individual intolerance to Clexane;
conditions accompanied increased risk development of bleeding - abortion, threatened miscarriage, aortic aneurysm, hemorrhagic stroke;
childhood(up to 18 years old);
presence of artificial heart valves in the patient’s body.

Injections should be administered with caution to elderly patients and people with liver or kidney diseases. Other things relative contraindications relate:

pathologies that are accompanied by impaired hemostasis - hemophilia, severe vasculitis, thrombocytopenia, hypocoagulation;
erosive and ulcerative lesions gastrointestinal tract;
recent ischemic stroke;
complicated diabetes mellitus;
recent childbirth, ophthalmological or neurological surgery;
performing spinal and epidural anesthesia;
performing a spinal tap;
use of intrauterine contraception;
pericarditis;
bacterial endocarditis;
severe arterial hypertension (high blood pressure).

Terms of sale and storage

The drug is released strictly according to prescription. Clexane should be stored according to the instructions at temperatures up to 25 °C. Shelf life – 3 years.

Analogs

If Clexane is not available in the pharmacy, the doctor may prescribe other medications with an identical principle of action. Analogs with the same active component are:

Clexane 300 – available in 3 ml bottles. It has completely similar indications and contraindications as Clexane. Available only by prescription.
Novoparin – solution for injection. Available in glass syringes of 1 or 2 pcs. on the packaging with instructions. Used for the prevention and treatment of thrombosis.
Enoxarin - low molecular weight heparin is available in dispensing syringes of 2, 4, 8 thousand anti-Xa ME. Prescribed for the treatment of deep vein thrombosis.

Fraxiparine or Clexane - which is better?

In case of individual intolerance to enoxaparin sodium, medications with similar pharmacological properties, but with a different active ingredient, are prescribed. An analogue of Clexan based on calcium nadroparin is Fraxiparine. The drug has the same list of indications, contraindications, and side effects. Detailed comparative studies There have been no studies between Clexane and Fraxiparine, so the choice of the preferred drug should be made by a doctor.

Clexane price

The cost of the injection solution may vary depending on the pricing of the pharmacy, the dosage of Clexane, and the number of disposable syringes in the package. Average prices in Moscow:

Video

Low molecular weight heparin (average molecular weight about 4500 Da), in which the antithrombotic and anticoagulant activities of standard heparin are separated. Unlike standard unfractionated heparin, it is characterized by high anti-Xa activity (100 IU/ml) and weak anti-IIa or antithrombin activity (28 IU/ml). When used in recommended doses, enoxaparin sodium does not increase bleeding time. IN prophylactic doses enoxaparin sodium does not lead to significant changes in activated partial thromboplastin time (aPTT), and also does not affect platelet aggregation and fibrinogen binding to platelets.
The pharmacokinetic parameters of the drug are assessed by changes in anti-Xa and anti-IIa activity in blood plasma over time in the recommended dose ranges.
When administered subcutaneously, Clexane is quickly and almost completely absorbed. Absorption is directly proportional to the administered dose and is linear. The bioavailability of enoxaparin sodium when administered subcutaneously approaches 100%. Maximum anti-Xa activity in blood plasma is observed between the 3rd and 5th hour after subcutaneous administration and averages 0.18±0.04 IU/ml after administration of 2000 anti-Xa IU and 0. 43±0.11 IU/ml after administration of 4000 anti-Xa IU, and 1.01±0.14 IU/ml after administration of 10,000 anti-Xa IU. Maximum anti-IIa activity is observed on average 4 hours after subcutaneous administration at a dose of 4000 anti-Xa IU, while at the same time, when administered at a dose of 2000 anti-Xa IU, this activity cannot be determined by the traditional amidolytic method. The volume of distribution of enoxaparin sodium for anti-Xa activity almost corresponds to the volume of circulating blood.
Metabolism of enoxaparin sodium occurs in the liver by desulfation and/or depolymerization to form low molecular weight heparin species with significantly lower biological potential. The half-life of anti-Xa activity corresponds to approximately 4 hours with a single dose and 7 hours with repeated administration. Anti-Xa activity is detectable up to approximately 24 hours after subcutaneous administration of 4000 anti-Xa IU enoxaparin sodium. Renal clearance of active metabolites is 10%, total renal excretion is 40% of the drug dose. Elimination of enoxaparin is longer in the elderly (half-life is 6-7 hours). In patients with renal failure (creatinine clearance ≤30 ml/min), AUC increases significantly (by 65%) with repeated administration of 4000 anti-Xa IU once daily. Pharmacokinetic parameters in patients with renal failure on hemodialysis do not change.

Indications for use of the drug Clexane

Prevention of venous thrombosis and embolism in orthopedic or general surgical operations, as well as in therapeutic patients who are on bed rest in connection with acute diseases(heart failure III-IV functional class according to NYHA classification, respiratory failure, severe acute infectious process, rheumatic diseases); prevention of thrombus formation in the extracorporeal circuit during hemodialysis; treatment of deep vein thrombosis, including those accompanied by thromboembolism pulmonary artery; treatment unstable angina and acute myocardial infarction without a pathological wave Q(in combination with acetylsalicylic acid).

Use of the drug Clexane

The drug is used only in adults. With preventive and medicinal use Enoxaparin is administered deeply subcutaneously. The drug is administered intravenously to achieve anticoagulation during hemodialysis.
Enoxaparin cannot be administered intramuscularly! Clexane is injected into the antero- or posterolateral area abdominal wall. The syringe needle is inserted over its entire length in a perpendicular direction to the surface skin fold, which is formed using a large and index finger and hold throughout the entire injection. The patient should be in a supine position. 1 mg of enoxaparin sodium (0.01 ml solution) corresponds to approximately 100 anti-Xa IU activity.
For the prevention of venous thrombosis and thromboembolism during operations with a moderate risk of thrombus formation (abdominal surgery) and in patients with a moderate risk of thromboembolism, the drug is recommended to be administered subcutaneously at a dose of 2000 anti-Xa IU once a day. For operations with a high risk of thromboembolism (hip or knee joint and oncological interventions), the drug is administered subcutaneously at a dose of 4000 anti-Xa IU once a day. In general surgical practice, the first dose of the drug is administered 2 hours before surgery. In orthopedic practice, the first dose of the drug is administered 12 hours before surgery. Duration prophylactic use averages 7-10 days. In orthopedics, it is used in a dose of 4000 anti-Xa once a day for up to 4 weeks.
In immobilized medical patients at high risk of thromboembolism, the recommended dose is 4000 anti-Xa IU once daily for at least 6 days, but not more than 14 days.
To prevent thrombus formation in the extracorporeal circuit during hemodialysis, the drug is used at a dose of 100 anti-Xa IU/kg of patient body weight. Enoxaparin is injected into the arterial line of the hemodialysis circuit before the start of the session. As a rule, the indicated dose is sufficient for dialysis for 4 hours; when fibrin rings appear, an additional dose of 50-100 anti-Xa IU/kg can be administered. For patients with a high risk of bleeding, the dose of the drug should be reduced to 50 anti-Xa IU/kg with dual vascular access and to anti-Xa IU/kg with single access. When fibrin rings appear, an additional dose of 50 to 100 anti-Xa IU/kg is administered.
In the treatment of deep vein thrombosis, which is accompanied or not accompanied by pulmonary embolism, enoxaparin sodium is administered subcutaneously at a dose of 150 anti-Xa IU/kg once a day or at a dose of 100 anti-Xa IU/kg 2 times a day every 12 h. The duration of treatment should not exceed 10 days. If necessary, oral anticoagulants are simultaneously prescribed. Treatment is continued until the international normalization ratio (INR) reaches 2-3.
In the treatment of unstable angina and myocardial infarction without a pathological wave Q V acute phase enoxaparin sodium is administered subcutaneously at a dose of 100 anti-Xa IU/kg every 12 hours (in combination with acetylsalicylic acid at a dose of 100-325 mg once a day orally). The duration of treatment is 2-8 days until the patient’s condition is clinically stabilized.
There is no need for dose adjustment for elderly people with normal function kidney
The use of enoxaparin sodium in children is not recommended.
In patients with renal failure (creatinine clearance ≤30 ml/min), dose adjustment of the drug is required, since its effect in this category of patients is significantly enhanced. WITH for preventive purposes For such patients, the drug is prescribed at a dose of 20 mg (2000 anti-Xa IU) once a day, for therapeutic purposes - 1 mg/kg (100 anti-Xa IU/kg) once a day.
Administration of the drug to patients with liver failure requires medical supervision.

Contraindications to the use of the drug Clexane

Hypersensitivity to enoxaparin or other low molecular weight heparins, acute hemorrhage or high risk of uncontrolled bleeding, including recent bleeding.

Side effects of the drug Clexane

Hemorrhagic complications are possible (including isolated cases of massive bleeding, in particular retroperitoneal and intracranial; some of these cases led to fatal outcome); local or generalized allergic reactions; thrombocytopenia (mild, transient, asymptomatic thrombocytopenia in the first days of therapy; immunoallergic thrombocytopenia with thrombosis, which in some cases was complicated by organ infarction or limb ischemia); at long-term treatment(more than 5 weeks) — early development osteoporosis; increased activity of transaminases in blood serum; the development of neuraxial hematomas when using enoxaparin during epidural or spinal anesthesia in some cases can lead to neurological disorders varying degrees severity, including the formation of prolonged or permanent paralysis; reactions at the injection site (from mild irritation to pain, bruising and hematomas at the injection site, in exceptional cases - skin necrosis); skin bullous rashes or systemic allergic reactions, including anaphylactoid. If such side effects occur, treatment with the drug must be stopped.
Isolated cases of hypersensitivity with cutaneous vasculitis have been reported; asymptomatic and reversible increase in platelet count and increase in liver enzyme activity.

Special instructions for the use of the drug Clexane

Low molecular weight heparins are not interchangeable drugs, since they differ in molecular weight, specific activity against factor Xa, and dosage regimen.
Clexane, like other anticoagulants, should be used with caution in conditions that are accompanied by an increased risk of bleeding, namely: with hemostasis disorders, a history of peptic ulcer, recently suffered, uncontrolled severe hypertension (arterial hypertension), diabetic retinopathy, neurosurgical or ophthalmological surgical interventions, simultaneous use of drugs that affect hemostasis.
During prophylactic treatment of patients over 65 years of age, no increased bleeding was observed, however, when using the drug in therapeutic doses There may be a risk of developing hemorrhagic complications.
Since there are not enough controlled clinical trials in pregnant women, enoxaparin sodium should be prescribed during pregnancy only if there are vital indications. It is not recommended to use Clexane for the treatment of pregnant women with prosthetic heart valves. It is recommended to stop breastfeeding during treatment with the drug.
Not used in pediatric practice.
In patients with low body weight (less than 45 kg in women and 57 kg in men), the risk of developing hemorrhagic complications increases, which requires monitoring the patient.
In order to reduce the risk of bleeding after percutaneous coronary angioplasty, the catheter providing vascular access should be removed no earlier than 6-8 hours after subcutaneous administration of enoxaparin. The next dose of enoxaparin can be administered only 6-8 hours after removal of the catheter.
When performing spinal or epidural anesthesia while using enoxaparin sodium at a dose of 4000 anti-Xa IU/kg once a day, cases of development of neuraxial hematomas and associated with them neurological disorders were rarely noted. The risk of developing such complications increases with the use of enoxaparin sodium in high doses, the use of permanent postoperative epidural catheters, or the simultaneous use of drugs that affect hemostasis, in particular NSAIDs, during repeated punctures.
When combined with spinal or epidural anesthesia and enoxaparin, it is best to install and remove the catheter before administering enoxaparin. When performing spinal or epidural anesthesia, it is best to insert and remove the catheter when the anticoagulant effect of enoxaparin sodium is low: 10-12 hours after administration at a dose of 4000 anti-Xa IU/kg or less, or 24 hours after administration of the drug in high doses (100 anti-Xa IU/kg 2 times a day or 150 anti-Xa IU/kg once a day). The next administration of enoxaparin sodium should be carried out no earlier than 2 hours after removal of the catheter. Strict medical monitoring of the patient's neurological status is necessary. If signs of a spinal hematoma appear, appropriate treatment should be immediately prescribed (if necessary, spinal cord decompression).
Medical supervision is required when prescribing the drug to patients with a history of heparin-induced thrombocytopenia with or without thrombosis.
It is recommended to determine the platelet count before and throughout the course of treatment. If the platelet count decreases by 30-50% of the initial value, the drug should be discontinued immediately.
Enoxaparin sodium in doses used for the prevention of venous thromboembolism does not significantly affect bleeding time and other parameters of blood coagulation, including platelet aggregation or fibrinogen binding to platelets. When using the drug in higher doses, the aPTT and activated clot formation time may increase. However, the increase in these indicators does not directly depend on the increase in the antithrombotic activity of enoxaparin and does not require constant monitoring.

Drug interactions Clexane

Due to the increased risk of bleeding, Clexane should not be used simultaneously with acetylsalicylic acid and other NSAIDs in high doses, ticlopidine, clopidogrel, dextran 40, corticosteroids, thrombolytics, anticoagulants, and other antithrombotic drugs, including glycoprotein IIb/IIIa antagonists. If it is necessary to use such combinations, careful clinical and laboratory monitoring should be carried out, however, today there is experience of safe combined use enoxaparin sodium with the above medicines.

Clexane overdose, symptoms and treatment

As a specific antidote, slow intravenous administration of protamine sulfate (hydrochloride) is indicated at the rate of 1 mg of protamine per 1 mg of Clexane (if enoxaparin sodium was administered over the previous 8 hours). However, even with the introduction of protamine sulfate into high dose the effect of enoxaparin sodium is not completely neutralized (maximum - up to 60%). Since neutralization may be temporary (due to the absorption characteristics of low molecular weight heparins), the dose of protamine must be divided into several injections (from 2 to 4) over 24 hours.

Storage conditions for the drug Clexane

At a temperature not exceeding 25 °C. Do not freeze.

List of pharmacies where you can buy Clexane:

Saint Petersburg

These are common diseases that almost everyone faces. If appropriate treatment is not provided in time, it may ultimately result in serious consequences up to and including death.

Modern pharmacological companies provide a huge selection of drugs for the treatment of these diseases. Each of them can not only relieve pain, but also the inflammatory process.

These drugs include the drug Clexane. It not only has anti-inflammatory properties, but also general strengthening effect, therefore it is often prescribed during prophylaxis before and after operations.

general information

Clexane is a medicine that belongs to the group. The drug is used for thrombosis and embolism. Active component The drug is enoxaparin sodium.

This component is also called heparin, which is in a low molecular state, obtained by hydrolysis of heparin with alkali (as an ester in benzyl form).

The main raw material for enoxaparin sodium is heparin, which is obtained from the intestinal mucosa of thin pigs.

Clexane contains the active substance enexparin sodium and a clear liquid with a yellow tint for injection.

Available in the form of syringes that are filled with clear liquid for injection under the skin. Syringes are available in different volumes - 0.2 ml, 0.4 ml, 0.6 ml, 0.8 ml and 1 ml, which contain 20 mg, 40 mg, 60 mg, 80 mg and 1 gram of the main component - enexoparin and water for injection as a solvent. 1 blister contains 2 syringes.

Pharmacological properties and pharmacodynamics

Clexane has antithrombotic properties. It is used as an injection under the skin during treatment coronary syndrome V acute form, deep vein thrombosis, as well as preventive treatment various pathologies veins

Second international generic name This drug is enoxaparin. The drug is a low molecular weight heparin with a molecular weight of approximately 4500 daltons.

While using the product for prophylactic treatment, he experiences a slight change in activated partial thromboplastin time. It also has almost no effect on platelet status and fibrogen binding. Also, during the treatment of various diseases with this drug, the aPTT increases almost 1.5-2 times.

After prolonged subcutaneous injections of a systematic nature in a volume of 1.5 mg per 1 kilogram of body weight maximum level Enoxaparin sodium in the body is achieved after two days. Bioavailability during subcutaneous administration is 100%.

Metabolization of enoxaparin in the liver is achieved through desulfation and depolymerization. The metabolites that are formed during this process have low activity.

The half-life of the drug lasts from 4 hours to 5 hours during a single dose. If the medicine is taken repeatedly – 7 hours. About 40% of the drug is excreted through the kidneys. Removal active substance enexoparin in older people occurs more slowly, this is due to deterioration of kidney function.

Indications for use

The main purpose of Clexane is to use it during preventive treatment for venous thrombosis, embolism, thromboembolism.

Clexane injections are also prescribed for the following indications:

recommended for patients who are on bed rest, who have suffered acute therapeutic illnesses - severe infectious diseases, the presence of respiratory and heart failure, heart failure in chronic form, acute rheumatic diseases with presence of risk factors for thrombus formation;
during surgical interventions;
prescribed for hemodialysis, but provided that the procedure lasts no more than 4 hours;
during varicose veins of deep veins which may or may not be accompanied by pulmonary embolism;
prescribed for unstable rhythm of angina pectoris and myocardial infarction. And also during acute myocardial infarction in patients who receive drug treatment procedures with coronary intervention.

Assignment restrictions

According to the instructions, the drug is not recommended for use for the following indications:

in the presence of hypersensitivity body to the main component– enoxaparin sodium, as well as heparin and its derivative components;
should not be taken under 18 years of age;
all kinds of diseases and conditions that are accompanied by an increased risk of severe bleeding - these include hemorrhagic stroke, aneurysm of the aorta or cerebral vessels of the head, as well as in the presence of enoxaparin- and heparin-induced thrombocytopenia in severe form, uncontrolled bleeding.

It is also worth paying attention to the fact that the drug should be used with extreme caution in the following conditions:

in the presence of renal or liver failure;
if you have a stomach ulcer or duodenum, as well as any other erosive and ulcerative lesions of the gastrointestinal tract;
at diabetes mellitus in severe form;
for retinopathy of hemorrhagic or diabetic type;
severe vasculitis;
problems with hemostasis;
bacterial endocarditis;
for uncontrolled hypertension arterial type heavy type;
when performing epidural or spinal anesthesia;
if there are severe injuries associated with the central nervous system;
if you have intrauterine contraception;
in the presence of extensive wounds with severe bleeding;
when taken simultaneously with drugs that affect the homeostasis system.

During pregnancy and lactation

The drug Clexane during pregnancy is prescribed in in rare cases. It is usually prescribed when the expected therapeutic effect for the mother is higher than the potential benefit for the child.

In addition, there is no information about whether enoxaparin sodium crosses the placental barrier during pregnancy.

If treatment with the drug is necessary during breastfeeding, then feeding should be stopped for the period of treatment.

Rules for use and dosage

The solution is administered using the injection method, with the patient in a supine position. The medicine is injected into the anterior or posterolateral abdominal wall at the site of the belt.

The needle should be inserted vertically completely, into the layer of skin that is sandwiched in the form of a fold. After insertion, the fold is not straightened. It is worth considering that after the injection the area does not need to be rubbed.

For venous thrombosis, varicose veins and thromboembolism

If the disease has average shape development with a slightly pronounced risk, Clexane is used 20 mg (0.2 g) for subcutaneous administration 1 time per day.

The medication is injected 2 hours before the operation and continues as long as there is a possibility of thromboembolic complications. The duration of the injections lasts about a week.

If the disease has severe form, then the drug is used at a dose of 40 mg (0.4 g) for subcutaneous administration once a day. The first administration is carried out 12 hours before surgery, and continues in the subsequent period, as long as there is a possibility of thromboembolic complications. Injections are given for approximately 10 days.

How to inject Clexane yourself - visual video:

Treatment of deep vein thrombosis

During deep vein thrombosis, the drug is prescribed in a dosage of 1 gram for injection under the skin. Injections are administered every up to 2 times a day every 12 hours.

Treatment is prescribed simultaneously with Clexane oral anticoagulants. The course of injections is 10 days.

Side effects

The instructions indicate side effects problems that may occur when using the drug:

bleeding;
the occurrence of thrombocytopenia;
skin rashes;
the occurrence of allergies, which may be systemic.

In addition, after administration of the drug, symptoms may appear. local reactions – painful sensations at the injection site, the appearance of hematomas, in rare cases, necrosis.

Also, many expert reviews note that when long-term treatment This drug may pose a risk of developing osteoporosis.

Opinions of specialists in various fields

From doctors' reviews about the drug Clexane.

In my opinion, the drug Clexane is good remedy for the treatment of thrombosis, embolism and thromboembolism.

In all my practice of using this drug, I can say with confidence that this remedy has a positive effect and leads to a quick recovery. But still, it should be used only according to indications and only after a doctor’s prescription.

Vascular surgeon

The drug Clexane works well both in the treatment of heart failure, myocardial infarction, and various diseases veins - varicose veins, thrombosis, embolism, thromboembolism. This remedy passed clinical trials and has proven its effectiveness. However, do not forget about side effects and contraindications; it is not advisable to use this remedy for hemorrhagic diseases and other conditions specified in the instructions.

Cardiologist

Voice of the People

Patients' thoughts.

My doctor prescribed Clexane to me to treat vein thrombosis. I did it in accordance with the instructions before the operation and subsequently in the subsequent period. My entire course of treatment lasted a week.

After treatment, I noticed relief, the pain went away, inflammation and heaviness went away. However, this product still has many contraindications and side effects, but it is so effective!

Lyudmila, 48 years old

I was prescribed the drug Clexane for the treatment of deep vein varicose veins and thrombosis. I have a high-risk disease.

I was given it at a dosage of 40 mg, first before the operation, then in the subsequent period. I received 10 injections in total. Of course, the condition has improved, but not by much. Perhaps I have a severe lesion and an advanced disease. And there are too many contraindications.

Mikhail, 52 years old

Price issue

The cost of the drug Clexane depends on the form of release and the volume of the syringe:

0.2 grams 10 pieces - from 1,750 rubles;
0.4 grams 10 pieces – from 2900 rubles;
0.6 grams 2 pieces – from 880 rubles;
0.8 grams 10 pieces – from 5000 rubles.

Fragmin;
Cibor;
Ostohont;
Gepalpan;
Troparin lmv.

Clexane is an anticoagulant direct action, refers to heparin and its derivatives, used for the treatment and prevention of thrombosis.

The drug exhibits antithrombotic properties and is used for subcutaneous injections in the treatment of acute coronary syndrome, deep vein thrombosis, as well as their prevention.

Enoxaparin sodium - the active substance - is obtained by alkaline hydrolysis of heparin (in the form of benzyl ether), produced from the mucous membrane small intestine pigs. Belongs to the group of low molecular weight heparins, exhibiting high anti-Xa activity, this substance differs insignificantly negative impact for thrombin.

Clexane is an effective antithrombotic agent with a rapid and long-lasting effect that does not adversely affect platelet aggregation.

Indications for use

What does Clexane help with? According to the instructions, the drug is prescribed in the following cases:

unstable angina, acute heart attack myocardium with ST segment elevation;
myocardial infarction without Q wave (with acetylsalicylic acid);
blood clots in deep veins, with or without pulmonary artery blockage;
drug treatment or subsequent percutaneous coronary intervention.

As a prophylactic:

thrombosis and embolism (blockage of blood vessels) during surgical operations, especially orthopedic and general surgery, in patients who are assigned to bed rest;
thrombus formation in the extracorporeal (artificial) circulation system.

Instructions for use of Clexane, dosage

The drug is intended for intravenous or deep subcutaneous administration. Intramuscular administration Absolutely forbidden. The injection should be performed in a lying position. A subcutaneous injection is performed into the left/right anterolateral or posterolateral areas of the abdominal wall.

For the prevention of venous embolism and thrombosis during surgical intervention administered at a dosage of 20 mg once daily subcutaneously. The first injection is performed two hours before surgery.

For patients with a high risk of embolism and thrombosis, the drug is administered at a dose of 40 mg subcutaneously 12 hours before surgery. According to the instructions for use, another dosage is also possible: 30 mg Clexane 12 and 24 hours after surgery.

The average course of treatment is 7-10 days. If necessary, the duration can be increased if the risk of thrombosis and embolism remains.

When performing orthopedic surgery, 40 mg is administered once a day for three weeks.

For prevention venous thrombosis and embolism in patients on bed rest due to acute therapeutic diseases Clexane is administered 40 mg per day subcutaneously for 6 days. Treatment continues until the patient is discharged, but not more than 14 days.

Treatment of deep vein thrombosis in combination with or without pulmonary embolism: 1.5 mg/kg once daily or 1 mg/kg twice daily. In patients with complicated thromboembolic disorders - 1 mg/kg 2 times a day. The duration of treatment is 10 days. It is advisable to immediately begin therapy with oral anticoagulants, while Clexane therapy must be continued until a sufficient anticoagulant effect is achieved (international normalizing factor 2-3).

Treatment of unstable angina and myocardial infarction without a Q wave: 1 mg/kg every 12 hours while simultaneously administering ASA at a dose of 100-325 mg once a day. The instructions recommend an average duration of therapy from 2 to 8 days (until stabilization clinical condition patient).

Prevention of thrombus formation in the extracorporeal bloodstream during hemodialysis: 1 mg/kg body weight. If there is a high risk of bleeding, the dose is reduced to 0.5 mg/kg with double vascular access or to 0.75 mg with single vascular access. During hemodialysis, Clexane should be injected into the arterial site of the shunt at the beginning of the hemodialysis session. One dose is usually sufficient for a 4-hour session, however, if fibrin rings are detected during longer hemodialysis, an additional 0.5-1 mg/kg can be administered.

special instructions

For severe renal failure the dose is adjusted depending on the CC value: for CC less than 30 ml/min - 1 mg/kg 1 time per day with therapeutic purpose and 20 mg 1 time per day for prophylactic purposes. The dosage regimen does not apply to cases of hemodialysis.

For mild to moderate renal failure, no dose adjustment is required.

Side effects

The instructions warn about the possibility of developing the following side effects when prescribing Clexane:

bleeding;
thrombocytopenia;
skin rashes;
allergic reactions, including systemic ones.

Local reactions may also occur: pain at the injection site, hematomas, and in rare cases, skin necrosis. There is a fairly high risk of developing osteoporosis in case of long-term treatment.

Contraindications

It is contraindicated to prescribe Clexane in the following cases:

The risk of bleeding is a threatened abortion, an aneurysm is a bulging wall of an artery (cerebral vessels, aortic dissection, hemorrhagic stroke, etc.).
Not prescribed to children and adolescents, used only after 18 years of age.
Hypersensitivity to the drug and its components.
Prescription for pregnant women with artificial heart valves is not recommended.
There is no data on the possibility of using the drug in patients with tuberculosis in active form and after recent radiation therapy.

Use with caution when:

renal and/or liver failure;
peptic ulcer of the stomach and duodenum or other erosive and ulcerative lesions Gastrointestinal tract;
severe diabetes mellitus;
hemorrhagic or diabetic retinopathy;
severe vasculitis;
hemostasis disorders;
bacterial endocarditis;
uncontrollable arterial hypertension severe form;
performing epidural or spinal anesthesia;
pericarditis or pericardial effusion;
severe injuries (especially the central nervous system);
intrauterine contraception;
open wounds with a large wound surface;
simultaneous use of drugs that affect the hemostatic system.

Prescribe with caution during postpartum recovery, as well as after a recent neurological or ophthalmological operation, ischemic stroke and spinal tap.

Overdose

Accidental overdose with IV, SC or extracorporeal use can lead to hemorrhagic complications. Even when taken orally large doses absorption of the drug is unlikely.

However, even with the introduction of protamine sulfate in a high dose, the effect of enoxaparin sodium is not completely neutralized (maximum - up to 60%).

Since neutralization may be temporary (due to the absorption characteristics of low molecular weight heparins), the dose of protamine must be divided into several injections (from 2 to 4) over 24 hours.

Drug interactions

The likelihood of bleeding increases when used simultaneously with ketorolac and other non-steroidal anti-inflammatory drugs, systemic salicylates, clopidogrel, ticlopidine, acetylsalicylic acid, dextran (with a molecular weight of 40 kDa), systemic glucocorticosteroids, anticoagulants, thrombolytics, glycoprotein IIb/IIIa antagonists and other antiplatelet agents. .

Do not alternate the use of enoxaparin sodium solution with other low molecular weight heparins.

Analogues of Clexane, price in pharmacies

If necessary, you can replace Clexane with an analogue according to therapeutic effect- these are drugs:

Anfiber,
Hemapaxan,
Novoparin,
Enixum,
Fraxiparine.

By ATX code:

Anfiber,
Hemapaxan,
Flenox NEO,
Enixum,
Enoxaparin sodium.

When choosing analogues, it is important to understand that the instructions for use of Clexane, price and reviews do not apply to drugs with similar effects. It is important to consult a doctor and not change the drug yourself.

Price in Russian pharmacies: Clexane solution for injection 8000 Anti-Xa IU/ml 80 g 0.8 ml – from 460 to 482 rubles, 2000 anti-Xa IU/0.2 ml No. 10 syringe – from 1689 to 1732 rubles, according to 482 pharmacies .

Store in a place protected from light at temperatures up to 25 °C. Keep away from children. Shelf life – 3 years. Dispensing conditions from pharmacies are by prescription.

Clexane is a drug whose main effect is to prevent blood clotting. It is actively used in traumatological, surgical, and orthopedic medical fields to prevent and treat the formation of blood clots in deep veins.

The use of Clexane helps prevent the formation of blood clots in the extracorporeal bloodstream. The drug is administered subcutaneously for the treatment of acute coronary syndrome.

Clexane is not recommended during pregnancy. However, many doctors prescribe this drug when indicated and in cases where positive impact on a woman’s body is significantly higher than the potential risk to fetal development. In addition, from of this medicine should be completely abandoned during breastfeeding.

The drug can only be used to prevent blood clots and myocardial infarction.

Contraindications to the use of Clexane during pregnancy

During pregnancy, the use of Clexane is prohibited if you have the following diseases and conditions:

ischemic stroke;
ulcerative diseases of the gastrointestinal tract and erosive lesions;
arterial hypertension;
recent surgery;
problems with the retina;
liver and kidney failure;
severe traumatic injuries;
intrauterine device;
inflammatory process localized in inner shell hearts;
diabetes mellitus at any stage;
homeostasis disturbances.

The consequences of using Clexane for these conditions are catastrophically dangerous. Only an experienced and qualified doctor can prescribe this drug during pregnancy, who must monitor the treatment.

In addition, the use of the medicine is highly not recommended for malignant neoplasms, overweight, heart failure.

At the same time, you should not combine the drug during pregnancy with other potent medications.

Drug administration technology

There is a certain technique for introducing Clexane into the body of a pregnant woman, which requires compliance with the following rules:

The drug must be injected as deep as possible under the skin.
Administration is possible in a lying position.
Intramuscular administration is prohibited.
If the administered dose does not exceed 20 mg, then the air should not be removed from the syringe to prevent “loss” of the drug.
The medicine must be injected into the left or right area peritoneum: a fold of skin is pinched with your fingers and a needle is vertically inserted into it along its entire length. The skin can be released only after complete administration of the drug.
It is forbidden to scratch or massage the injection site.

Clexane is a clear, colorless solution that is available as a solution. The main active ingredient of the drug is enoxaparin sodium.

If there is a risk of blood clots or during surgical intervention 20-40 mg of medication is administered daily. If surgery is planned, Clexane must be administered 100-120 minutes before the start of surgery.

If there is a risk of blood clots arising during surgery, Clexane should be administered once 12 hours before surgery.

Diseases of the respiratory system are a contraindication to the use of Clexane

The duration of treatment with this drug is 7-10 days. If, upon completion of the therapeutic course, there are risks of developing pathologies, then treatment continues until the main manifestations of the disease disappear.

To prevent thrombosis and embolism in pregnant women, Clexane is used once a day. The duration of treatment in this way is 1-2 weeks (no more).

Indications for use

The drug is used to treat a number of diseases, including during pregnancy, the main of which are:

acute form of respiratory or heart failure;
thrombosis;
myocardial infarction;
infectious and rheumatic diseases;
unstable angina.

During pregnancy, it is recommended to inject Clexane in smaller and reduced dosages. Only a doctor can determine the exact dose. Given the complexity of the injection procedure, it should only be performed qualified specialist. Self-treatment using this drug is prohibited.

Side effects of using Clexane during pregnancy

When treated with this drug, there is a relatively high risk of bleeding. In such situations, further use of the medicine is strictly prohibited. Treatment is symptomatic.

In rare cases, the appearance of hemorrhoidal syndrome is observed, against the background of which hemorrhages appear in the cranial region and the space behind the peritoneum. There is a possibility of death.

In situations where the drug is used during catheterization of a patient or spinal anesthesia, a hematoma of the spinal space with various neurological disorders is likely to occur.

Thrombocytopenia may often develop at the very beginning of treatment. In this case, it is not clinically significant because it is transient.

Most often, all kinds of local reactions are observed in the area of subcutaneous administration of the drug:

pain at the injection site;
the appearance of a small hematoma;
formation of a dense infiltrate;
formation of erythematous plaques.

All allergic reactions associated with the use of this drug are limited skin manifestations. In exceptional cases, systemic reactions develop. The most dangerous effect is vasculitis.

Drug overdose

Cases of overdose with Clexane are possible only when the drug is administered in large volumes intravenously or subcutaneously. Oral administration medications reduces the likelihood of overdose to a minimum.

The antidote for Clexane is protamine sulfate. To neutralize 1 mg of the drug, 1 mg of the substance is required. In this case, it is possible to neutralize the medicine only when the drug was administered less than 8 hours ago. If it was introduced earlier, then 0.5 mg of protamine sulfate will be enough.

Clexane should not be mixed with other potent drugs. Also, simultaneous use with low molecular weight heparins is not allowed.

Clexane during pregnancy can only be prescribed by the attending physician, after he has studied the patient’s medical history, assessed her condition, the presence of contraindications for use and other factors that may negatively affect a person’s health after the start of treatment.

It was already noted above that Clexane is used in reduced dosages during pregnancy. During breastfeeding, the use of the drug is excluded.