Clexane Injection Uses

Clexane is a brand name for the medication enoxaparin, which is a type of anticoagulant or blood thinner. Enoxaparin is primarily used for its anticoagulant properties, and it is administered through subcutaneous (under the skin) injections.

The following are some common uses and indications of Clexane Injection

1. Deep Vein Thrombosis (DVT): Clexane is often used to prevent and treat deep vein thrombosis, which is a blood clot that forms in a deep vein, usually in the legs.
2. Pulmonary Embolism (PE): It’s used to prevent and treat pulmonary embolism, which occurs when a blood clot breaks loose and travels to the lungs, potentially blocking blood flow.
3. Stroke: In certain cases, Clexane may be used as part of the treatment for stroke, especially if the stroke was caused by a blood clot.
4. Unstable Angina and Non-ST Segment Elevation Myocardial Infarction: It is used in combination with aspirin to treat these conditions, which involve chest pain and potential heart attack risks due to blood clot formation.
5. Atrial Fibrillation (AFib): In some cases, Clexane might be prescribed for people with atrial fibrillation, a heart rhythm disorder that can increase the risk of blood clots.
6. Certain Surgeries: It may be given before and after surgery, particularly orthopedic surgeries like hip and knee replacement, where there is a higher risk of blood clots forming.
7. Kidney Disorders: In certain kidney disorders, where the blood has a higher tendency to clot, Clexane might be prescribed to prevent clot formation.
8. Cancer Patients: Some cancer patients may be given Clexane to prevent or treat blood clots, especially if they are undergoing chemotherapy.
9. Pregnancy: Clexane may be prescribed for pregnant women with certain medical conditions or a history of blood clots to prevent complications like deep vein thrombosis or miscarriage.

Off-label Uses of Clexane Injection

1. Antiphospholipid Syndrome (APS): This is an autoimmune disorder where the body mistakenly produces antibodies that attack phospholipids, which are important components of cell membranes. APS can lead to blood clots, recurrent miscarriages, and other complications. Clexane may be used in some cases to prevent clotting in individuals with APS.
2. Prevention of Catheter-Related Thrombosis: In certain situations, particularly in critically ill patients with central venous catheters, Clexane might be used to reduce the risk of catheter-related blood clots.
3. Thromboprophylaxis in Pediatric Patients: While not explicitly approved for children, Clexane might be used in pediatric patients in specific situations where the benefits outweigh the potential risks, especially for conditions like DVT or PE.
4. Sickle Cell Disease: Some studies have investigated the use of Clexane in patients with sickle cell disease to reduce the risk of vaso-occlusive crises and associated complications.
5. Recurrent Pregnancy Loss (RPL): In cases where recurrent miscarriages are believed to be related to blood clotting disorders, Clexane might be considered to improve pregnancy outcomes.
6. Arterial Thrombosis: Although Clexane is primarily used for venous thrombosis, there may be situations where it is considered in arterial thrombosis, especially when other options are contraindicated.
7. Extracorporeal Membrane Oxygenation (ECMO): In some cases of severe respiratory or cardiac failure where ECMO is used, Clexane may be employed to prevent clotting within the ECMO circuit.
8. Liver Transplantation: Clexane may be used in the postoperative period to prevent clotting in liver transplant recipients, who are at higher risk due to the surgical procedure and the altered coagulation status associated with liver disease.

Clexane is one of the leading Injectable brands of Enoxaparin, manufactured and marketed by Sanofi Aventis (Pakistan) Ltd.

The following are Some alternative brands of Clexane and their manufacturers.

• Clotles-SS : Himont Chemical (Pvt) Ltd, Pakistan.
• Enox : Wilsons Pharmaceuticals, Pakistan.
• Oxaprin : Werrick Pharmaceuticals.
• Prolongin : Kurative Pak (Pvt) Ltd.

Presently, Clexane is available in Injection form.

Clexane Injection : 20mg, 40mg, 60mg, and 80mg strengths

Clexane (enoxaparin sodium) injections should not be used in certain circumstances due to potential risks and interactions.

1. Hypersensitivity or Allergy: Individuals with a known hypersensitivity or allergy to enoxaparin sodium or any of the other components of Clexane should not use this medication.
2. Active Major Bleeding: Clexane is an anticoagulant, which means it thins the blood and can increase the risk of bleeding. It should not be used in cases of active, clinically significant bleeding, such as gastrointestinal bleeding, intracranial bleeding, or bleeding disorders.
3. Heparin-Induced Thrombocytopenia (HIT): Clexane should be avoided in patients with a history of heparin-induced thrombocytopenia, a rare but serious reaction to certain types of heparin.
4. Thrombocytopenia with a Positive In Vitro Test for Antibodies: If a patient has a low platelet count (thrombocytopenia) with a positive in vitro test for antibodies to heparin and platelet factor 4, it is advised not to use Clexane.
5. Severe Hypertension: Clexane should be used with caution in patients with uncontrolled severe hypertension.
6. Epidural or Spinal Anesthesia/Analgesia: Clexane should not be used in patients receiving epidural or spinal anesthesia/analgesia or undergoing spinal puncture due to the risk of epidural or spinal hematoma, which can lead to paralysis.
7. Bacterial Endocarditis: Clexane is contraindicated in patients with bacterial endocarditis (infection of the heart’s inner lining), as it can increase the risk of embolic complications.
8. Uncontrolled Severe Thrombocytopenia: In patients with a very low platelet count, Clexane should be used with caution and only if the benefits outweigh the risks.
9. Severe Liver or Kidney Impairment: Clexane should be used with caution in patients with severe liver or kidney impairment, as it may be cleared from the body more slowly, potentially leading to an increased risk of bleeding.
10. Recent Surgery of the Eye, Brain, or Spinal Cord: Clexane should be used cautiously in the immediate postoperative period after surgeries involving the eye, brain, or spinal cord.
11. Severe Uncontrolled Hypertension: Clexane should be used with caution in patients with severe, uncontrolled hypertension.

Clexane Injection for Prevention of Deep Vein Thrombosis (DVT):

• Standard Dosing for Adults: One Injection of 40mg once daily, administered subcutaneously (under the skin).
• High-Risk Patients (e.g., orthopedic surgery): In high-risk patients, such as those undergoing hip or knee replacement surgery, the initial dose may be increased to 40mg twice daily for a specified duration, which is then reduced to 40mg once daily.

Clexane Injection for the Treatment of Deep Vein Thrombosis (DVT):

• Standard Dosing for Adults: 1 mg/kg administered subcutaneously every 12 hours or 1.5 mg/kg administered subcutaneously once daily.
• Outpatient Treatment: In some cases, a once-daily dosing regimen may be used for outpatient treatment of DVT.

Clexane Injection for Prevention of Blood Clots in Angina or Heart Attack (Unstable Angina/Non-ST Segment Elevation Myocardial Infarction):

• Clexane is typically administered in combination with aspirin. The recommended dose is 1 mg/kg every 12 hours administered subcutaneously.

Clexane Injection for Treatment of Acute ST-Segment Elevation Myocardial Infarction (STEMI):

• The recommended dose is 30 mg IV bolus followed by 1 mg/kg administered subcutaneously every 12 hours (maximum 100 mg for the first two doses only).

Clexane Injection for Other Conditions (Off-label or Special Situations):

• For off-label uses or special situations, the dosing and administration will be determined by the healthcare provider based on the specific medical condition and the patient’s individual factors.

Administration Guidelines

• Clexane is administered subcutaneously, typically in the fatty tissue of the abdomen. It should not be injected into muscle.
• The injection site should be rotated to prevent irritation or lumps at the injection site.
• To minimize bleeding, pressure should be applied at the injection site for a few seconds after the needle is withdrawn.
• The medication should be visually inspected for any discoloration or particles before administration. If either is present, it should not be used.

Clexane Injection works by binding to antithrombin III, a natural protein in the blood that inhibits blood clots. When Clexane binds to antithrombin III, it enhances its ability to inactivate factor Xa and factor IIa, two key enzymes involved in the blood clotting process.

Factor Xa is involved in the conversion of prothrombin to thrombin, and factor IIa is thrombin itself. By inhibiting factor Xa and factor IIa, Clexane prevents the formation of new blood clots and helps to break down existing clots.