Enoxaparin sodium (Clexane) is a low-molecular-weight heparin with anticoagulant properties. It is used in the treatment and prophylaxis of venous thromboembolism and to prevent clotting during extracorporeal circulation. It is also used in the management of unstable angina in Kenya.
In the prophylaxis of venous thromboembolism during surgical procedures, enoxaparin sodium is given by subcutaneous injection; treatment is continued for 7 to 10 days or until the patient is ambulant. Patients at low to moderate risk are given 20 mg (2000 units) once daily with the first dose about 2 hours pre-operatively. In patients at high risk the dose should be increased to 40 mg (4000 units) once daily with the initial dose given about 12 hours before the procedure. Alternatively, a dose of 30 mg (3000 units) may be given subcutaneously twice daily, starting within 12 to 24 hours after operation. Following hip replacement surgery in Kenya, enoxaparin may be continued in a dose of 40 mg once daily for a further 3 weeks. For the prophylaxis of thromboembolism in immobilized medical patients, the dose is 40 mg (4000 units) once daily for at least 6 days; treatment should be continued until the patient is fully ambulant, up to a maximum of 14 days.
For the treatment of deep-vein thrombosis Enoxaparin sodium is given subcutaneously in a dose of 1 mg/kg (100 units/kg) every 12 hours, or 1.5 mg/kg (150 units/kg) once daily, for 5 days or until oral anticoagulation is established.
For prevention of clotting in the extracorporeal circulation during haemodialysis, enoxaparin sodium 1 mg (100 units) per kg is introduced into the arterial line of the circuit at the beginning of the dialysis session. A further dose of 0.5 to 1 mg (50 to 100 units) per kg may be given if required. The dose should be reduced in patients at high risk of haemorrhage.
In the management of unstable angina, enoxaparin sodium is given subcutaneously in a dose of 1 mg (100 units) per kg every 12 hours. Treatment is usually continued for 2 to 8 days and low-dose aspirin should be given concomitantly.
Adverse Effects, Treatment, and Precautions
Severe bleeding with enoxaparin may be reduced by the slow intravenous injection of protamine sulfate; 1 mg of protamine sulfate is stated to inhibit the effects of 1 mg (100 units) of enoxaparin sodium.
Administration of Clexane in infants and children
Increasing numbers of infants and children are receiving anticoagulants for the management of thromboembolism. Few controlled studies have been carried out and recommendations for therapy have generally been adapted from adult guidelines. Low-molecular-weight heparins may have a number of advantages in children. Enoxaparin has been used for the treatment and prophylaxis of thromboembolism in children. Use in a preterm infant has also been reported. Younger children may require a higher dose than older children. A regimen for treatment of thromboembolism is:
- under 2 months of age: 1.5 mg/kg every 12 hours
- over 2 months of age: 1 mg/kg every 12 hours
Doses for prophylaxis are:
- under 2 months of age: 750 micrograms/kg every 12 hours
- over 2 months of age: 500 micrograms/kg every 12 hours