Clexane during pregnancy - rules for safe use. "Clexane" during pregnancy: use and contraindications

With an increased risk of developing thrombosis or, if necessary, their treatment, doctors often prescribe Clexane during pregnancy. This remedy is referred to as direct-acting anticoagulants, which are used to prevent the formation of blood clots.

Many are afraid to inject Clexane, because even the instructions for use indicate that adequate studies on expectant mothers have not been conducted. But it is prescribed only on condition that the use of the drug is necessary. Especially the question of the admissibility of using Clexane worries women who have a mechanical valve installed in the heart.

Indications for the use of the drug

It can be difficult for women suffering from a predisposition to thrombosis to bear a baby. In some cases, it is better if a woman starts using direct-acting anticoagulants even when planning a pregnancy. Indications for the appointment of Clexane include:

• embolism prevention;
• prevention of thrombosis;
• treatment of conditions accompanied by the formation of blood clots in deep veins;
• forced prolonged bed rest due to acute respiratory or heart failure, rheumatic processes, infectious lesions;
• treatment of coronary heart disease.

The instructions for use contain information that it is prescribed as a prophylactic agent if surgical interventions are necessary.

If a woman cannot use Clexane during pregnancy, then another anticoagulant may be prescribed to her. It could be Fraxiparine. Both of these drugs are considered direct-acting anticoagulants, but the main substance in Clexane is enoxaparin sodium. And Fraxiparine is made on the basis of calcium nadroparin.

Features of the use of Fraxiparine

As an analogue of Clexane, the doctor may advise the use of Fraxiparine. This low molecular weight heparin is prescribed:

• for the treatment of thromboembolism;
• for therapy in conditions threatening the development of a heart attack;
• as a prophylactic in the event of the likelihood of thromboembolic complications;
• with myocardial infarction, in which the Q wave is absent.

Thromboembolic complications may occur during surgical or orthopedic interventions. They also develop with limited mobility due to heart or respiratory failure.

Fraxiparine should not be prescribed if there have already been unpleasant consequences as a result of taking it in anamnesis. These include the development of thrombocytopenia when using nadroparin. Also, you can not prick Fraxiparine in such cases:

• ulcerative lesions of organs;
• violation of hemostasis and the associated increase in the risk of bleeding;
• intracranial hemorrhages;
• severe degree of renal failure.

The instructions for use indicate that in all other situations that are accompanied by an increased risk of bleeding, Fraxiparine is prescribed with caution. The dosage in each case is selected individually.

Contraindications for use

The list of situations in which the instructions for use recommend not using this direct-acting anticoagulant include:

• diseases that are accompanied by an increased likelihood of bleeding, exceptions are made only for taking it during planned surgical operations;
• increased susceptibility to heparin, including enoxaparin;
• the presence of mechanical heart valves in pregnant women.

Situations that increase the chance of bleeding include:

• the threat of spontaneous abortion;
• aneurysm of blood vessels located in the brain;
• dissecting aortic aneurysm;
• a history of severe thrombocytopenia associated with the use of heparin.

Instructions for use recalls the need for caution when taking Clexane in such situations:

• violations of hemostasis;
• ulcerative lesions of various organs;
• severe form of vasculitis;
• diabetes;
• bacterial endocarditis;
• open wounds with a large area of ​​damage.

Application features

Instructions for use contains information on how exactly this drug should be used. It must be injected deeply subcutaneously. Intramuscular injections of Clexane are prohibited.

Doctors recommend injecting when the patient is in a supine position. It is better to carry out injections alternately in the right and left areas of the anterolateral or posterolateral surface of the abdomen. For the injection, it is necessary to make a skin fold with the thumb and forefinger. The needle is inserted into the formed fold completely strictly vertically. The skin is released only after the administration of the drug is completed. After the injection, massaging this area is prohibited.

In most situations, treatment with Clexane should last 7-10 days. The same duration of therapy should be when using Fraxiparine.

The required dosage of the anticoagulant is selected depending on the indications, condition and weight of the woman. To prevent the development of thrombosis, doctors may recommend administering 40 mg of Clexane once a day for 1-2 weeks. But for the treatment of deep vein thrombosis, it is necessary to administer 1.5 mg per kg of body weight once a day or 1 mg twice.

Is it worth doing injections: women's opinions

The question of the advisability of using direct anticoagulants is not even discussed if a woman has an increased tendency to thrombosis. But many are afraid to inject until they find out the reviews of other pregnant women.

When using Clexane, a woman should be prepared for the fact that side effects may begin to appear. Injections can provoke:

• the onset of bleeding (gastric, nasal);
• the appearance of hematomas;
• the occurrence of hematuria;
• thrombocytosis;
• thrombocytopenia;
• allergic reactions;
• swelling, pain, increased sensitivity at the injection site.

But the lack of such treatment can cause a halt in fetal development. And this means that without injections of anticoagulants, a woman will not be able to bear a child. Left untreated, it can also harm a woman's health. It is desirable that this drug is prescribed not by a therapist or gynecologist leading the pregnancy, but by a hematologist.

The doctor must choose the most suitable remedy. Despite the fact that Clexane and Fraxiparine belong to low molecular weight heparins, they cannot be called analogues. Therefore, the choice should be made by the doctor, based on the indications, the condition of the pregnant woman and his personal experience in using these drugs.

When choosing the most suitable remedy, you should not focus on the price, although the difference between the cost of Clexane and Fraxiparine is small. A pack of 10 syringes of 20 mg / 0.2 ml will cost 1661 rubles, 40 mg / 0.4 ml - 2601 rubles, 80 mg / 0.8 ml - 4150 rubles. And for 10 injections of Fraxiparine 9500 IU / 0.8 ml, you will have to pay 4500 rubles, 5700 IU / 0.6 ml - 3872 rubles, 2850 IU / 0.3 ml - 2539 rubles.

Latin name: Clexane
ATX code: B01AB05
Active substance: Enoxaparin sodium
Manufacturer: Sanofi-Aventis, France
Vacation from the pharmacy: On prescription
Storage conditions: t up to 25 C
Best before date: three years.

Clexane is a low molecular weight form of heparin and belongs to the group of direct acting anticoagulants.

Indications for use

Not everyone knows why Clexane is prescribed. Its use is indicated in the treatment of:

• Thrombosis localized in deep veins, which is accompanied by pulmonary embolism
• Angina pectoris (unstable form) and myocardial infarction, in which the Q wave is not observed on the ECG (combined with aspirin).

Prophylactic medication Clexane is indicated:

• To prevent the formation of blood clots in the veins, as well as thromboembolism
• To prevent thrombosis, as well as thromboembolism in the presence of a number of therapeutic ailments (serious pathologies of the cardiovascular system, the development of an acute infection, impaired respiratory function, detection of acute rheumatic ailments with a risk of blood clots in the veins)
• In order to prevent thrombosis directly in the extracorporeal circulation system during the hemodialysis procedure.

Composition and forms of release

One syringe may contain 2000, 4000, 6000 and 8000 anti-Xa IU of the main active ingredient, which is enoxaparin sodium. The solution also contains water.

Clexane solution is transparent, light yellow, sold in 0.2 ml, 0.4 ml, 0.6 ml and 0.8 ml syringes. In bliss. The package contains 2 syringes, inside the pack 1 or 5 blisters. packages.

Medicinal properties

The international non-proprietary name (INN) of the drug is enoxaparin, which does not coincide with the name in Latin. The drug is a low molecular weight heparin, its molecular weight is about 4500 Da. The process for obtaining enoxaparin is based on alkaline hydrolysis (heparin benzyl ether is used, which is obtained from the intestinal mucosa of a pig).

In the case of the use of Clexane in prophylactic dosages, a slight change in APTT is observed, the drug has practically no effect on the process of platelet cell aggregation and subsequent binding to the fibrogen itself. The therapeutic dose of the drug increases the APTT by approximately 1.5-2.2 r.

After regular subcutaneous injections at a dose of 1.5 mg per 1 kg of body weight per day, the achievement of an equilibrium concentration is observed after 48 hours. The bioavailability index for subcutaneous infusion is 100%.

Metabolic transformations of enoxaparin sodium occur in the liver cells. Due to the processes of depolymerization, as well as desulfation, the formation of metabolites characterized by reduced activity is observed.

The duration of the half-life does not exceed three to four hours with a single injection and no more than 7 hours with multiple infusions of the drug.

In the elderly, the excretion of the active substance of the drug may be delayed. This is due to the deterioration of the renal system.

In the case of kidney pathology, a decrease in the clearance of enoxaparin may be observed.

Clexane: full instructions for use

The drug must be administered subcutaneously, before the injection, the patient must take a supine position.

How to do injections

Not everyone knows where to inject Clexane. The medicine is injected into the abdomen (alternately to the left and to the right side). Before injecting Clexane, it is necessary to open the syringe and insert the needle strictly vertically as deep as possible into the skin fold, which was formed with the thumb and forefinger. Do not rub the skin at the injection site.

It is worth remembering that injections are not given intramuscularly.

Scheme of injections

Price: from 161 to 4850 rubles.

Make 2 injections per day, the time interval between exposures should be at least 12 hours. For one injection, the dose is calculated as follows - 100 anti-Xa IU per 1 kg of body weight.

Persons who have an average risk of developing thrombosis are injected with a solution of Clexane 0.2 ml once a day. It is worth noting that the first injection should be given approximately two or three hours before the proposed surgical intervention.

Persons with an increased risk of thrombosis should be given a solution of Clexane 0.4 ml once a day (the first injection is given 12 hours before surgery) or Clexane 6000 for two or three applications (the first injection is given 13-24 hours before surgery). How long the treatment will last, it is worth checking with the doctor, but on average, the drug is prescribed for 7-10 days. If necessary, it is possible to extend the treatment until there is a risk of thrombosis.

During the treatment course for deep venous thrombosis, a dose of 1.5 mg of drugs per 1 kg of body weight should be administered. The duration of treatment with a blood thinner is 10 days.

To prevent thrombosis, as well as vein embolism in people on bed rest, it is prescribed to administer 40 mg of the drug once a day. The duration of treatment with Clexane is 6-14 days.

The use of Clexane during pregnancy, GV

It is worth noting that Clexane is not usually used during pregnancy, its use is allowed in exceptional cases, when the therapeutic effect expected in the mother significantly exceeds the possible consequences for the child. They buy medicine only after an accurate diagnosis has been made and a prescription has been issued. Pregnant women should be treated under the supervision of a doctor in order to exclude the development of pathologies in the child.

It is worth remembering that Clexane during pregnancy is first prescribed in the minimum dosage.

The drug can be prescribed in the postpartum period, namely after a caesarean section. Why injections are prescribed, you should check with your doctor. The duration of treatment with Clexane after childbirth is determined individually.

With HB, the use of the drug is undesirable.

Contraindications and precautions

You should not start drug therapy when:

• Allergy to drug components
• Illnesses in which the risk of opening bleeding is increased
• Pregnancy if the woman had heart valves installed

With special care, treatment should be carried out with:

• Ulcerative and erosive pathologies of the gastrointestinal tract
• Previous ischemic stroke
• Elevated blood pressure
• Severe diabetes
• recent delivery
• Pathologies that are accompanied by a violation of hemostasis and with severe vasculitis
• Use of intrauterine contraceptives
• Signs of pericarditis
• Serious pathologies of the liver and kidney system
• Retinopathy, non-proliferative or hemorrhagic
• Presence of serious injuries
• Bacterial form of endocarditis
• Spinal or epidural anesthesia
• Simultaneous use of drugs that affect the hemostasis system
• spinal puncture
• Recent ophthalmic and neurosurgical operations.

You should not buy the drug on "buy-sell" ad sites, since those that write "sell Clexane" cannot guarantee the originality of drugs. If you nevertheless responded to the ad "I will sell Clexane", check the integrity of the package and the expiration date.

Cross-drug interactions

Do not mix this drug with other drugs. Alternate use of Clexane with other drugs containing low molecular weight heparins is not recommended.

During the parallel use of aspirin, dextran, NSAIDs, thrombolytics, clopidogrel, anticoagulant drugs and ticlopidine, the likelihood of bleeding increases.

Alcohol compatibility

Side effects and overdose

As with other anticoagulant treatments, there is an increased risk of bleeding, and this risk is increased with invasive procedures and with medications that interfere with hemostasis. When bleeding is discovered, the medicine is canceled, a comprehensive diagnosis is carried out aimed at identifying the cause, after which the necessary treatment is prescribed.

If epidural or spinal anesthesia was performed during medical therapy, neuraxial hematomas may occur due to the subsequent use of catheters. Such pathologies subsequently lead to the development of neurological ailments of varying severity, very rarely - irreversible paralysis is possible.

There is a possibility of developing thrombocytopenia in people who are being treated after a myocardial infarction (elevated ST-segment) and are undergoing therapy to prevent venous thrombosis.

After the injections, the occurrence of a local hematoma can be observed, very rarely necrotic changes in the skin at the injection site are recorded.

The possibility of developing anaphylactic reactions and a short-term increase in the activity of hepatic transaminases is not excluded.

In some cases, it will be necessary to replace the drug Clexane, analogues are selected by the attending physician. Specify which medicine is cheaper (tablets, solution) and how best to store it.

With the inadvertent administration of increased dosages, the subsequent development of hemorrhagic complications may be observed. In the case of oral administration, there is a very low probability of drug entry into the general circulation.

An intravenous infusion of protamine sulfate is recommended, 1 mg of this substance is able to neutralize 1 mg of enoxaparin. If more than half a day has passed after an overdose, there is no need to administer protamine sulfate.

Analogues

Sanofi-Aventis, France

Price from 1050 to 1430 rubles.

The drug in a volume of 1 ml contains an increased dosage of enoxaparin - 10,000 anti-Xa MO. The drug is used to thin the blood, thus, it is possible to effectively treat thrombosis and prevent their development in the future. The solution is available in bottles, the volume of which is three milliliters.

Pros:

• Rarely provokes the development of allergies
• Rapid therapeutic action
• Taking the drug does not affect the ability to drive a car.

Minuses:

• Difficult to find in pharmacies
• Not suitable for children under 3 years of age
• Contraindicated in intracerebral hemorrhage.

Glaxo Wellcome Production, France

Price from 269 to 6183 rubles.

Fraxiparine belongs to the group of anticoagulant drugs that prevents the formation of blood clots. Indicated for the prevention of thromboembolic complications. The main active ingredient is calcium nadroparin. Fraxiparine release form - solution.

Pros:

• Can be used to prevent thromboembolism in surgery
• Ease of use due to the presence of a special syringe
• It can be prescribed during the IVF protocol.

Minuses:

• Not used in pediatrics
• Cannot be administered intramuscularly
• May cause thrombocytopenia.

*registered by the Ministry of Health of the Russian Federation (according to grls.rosminzdrav.ru)

INSTRUCTIONS
on the use of the medicinal product
for medical use Clexane ®

Registration number:

Tradename:

International non-proprietary name:

Dosage form:

Composition per syringe

* - weight calculated based on the content of sodium enoxaparin used (theoretical activity 100 anti-Xa IU/mg).

Description: clear, colorless to pale yellow solution.

Pharmacotherapeutic group:

ATX code- B01AB05.

Pharmacological properties

Pharmacodynamics
In a clean system in vitro Enoxaparin sodium has high anti-Xa activity (about 100 IU/ml) and low anti-IIa or antithrombin activity (about 28 IU/ml). This anticoagulant activity acts through antithrombin III (AT-III) to provide anticoagulant activity in humans. In addition to anti-Xa/IIa activity, additional anticoagulant and anti-inflammatory properties of enoxaparin sodium have also been identified both in healthy people and patients, and in animal models. This includes AT-III dependent inhibition of other clotting factors such as factor VIIa, activation of tissue factor pathway inhibitor (PTF) release, and reduced release of von Willebrand factor from the vascular endothelium into the circulation. These factors provide the anticoagulant effect of enoxaparin sodium in general. When used in prophylactic doses, it slightly changes the activated partial thromboplastin time (APTT), has virtually no effect on platelet aggregation and the degree of fibrinogen binding to platelet receptors. Plasma anti-IIa activity is approximately 10 times lower than anti-Xa activity. The average maximum anti-IIa activity is observed approximately 3-4 hours after subcutaneous administration and reaches 0.13 IU / ml and 0.19 IU / ml after repeated administration of 1 mg / kg of body weight with a double injection and 1.5 mg / kg body weight with a single injection, respectively. The average maximum anti-Xa plasma activity is observed 3-5 hours after subcutaneous administration of the drug and is approximately 0.2; 0.4; 1.0 and 1.3 anti-Xa IU/ml after subcutaneous administration of 20, 40 mg and 1 mg/kg and 1.5 mg/kg, respectively.

Pharmacokinetics
The pharmacokinetics of enoxaparin in these dosing regimens is linear. Variability within and between patient groups is low. After repeated subcutaneous administration of 40 mg of enoxaparin sodium once a day and subcutaneous administration of enoxaparin sodium at a dose of 1.5 mg/kg of body weight once a day in healthy volunteers, the equilibrium concentration is reached by day 2, with an average area under the pharmacokinetic curve of 15 % higher than after a single injection. After repeated subcutaneous injections of enoxaparin sodium at a daily dose of 1 mg / kg of body weight twice a day, the equilibrium concentration is reached after 3-4 days, and the area under the pharmacokinetic curve is on average 65% higher than after a single injection, and the average values ​​​​of maximum concentrations are respectively 1.2 IU / ml and 0.52 IU / ml. The bioavailability of enoxaparin sodium when administered subcutaneously, estimated on the basis of anti-Xa activity, is close to 100%. The volume of distribution of anti-Xa activity of enoxaparin sodium is approximately 5 liters and approaches the blood volume. Enoxaparin sodium is a low clearance drug. After intravenous administration for 6 hours at a dose of 1.5 mg/kg of body weight, the average clearance of anti-Xa in plasma is 0.74 l/hour.
Elimination of the drug is monophasic with half-lives of 4 hours (after a single subcutaneous injection) and 7 hours (after repeated administration of the drug). Enoxaparin sodium is mainly metabolized in the liver by desulfation and / or depolymerization with the formation of low molecular weight substances with very low biological activity. The excretion through the kidneys of the active fragments of the drug is approximately 10% of the administered dose, and the total excretion of active and inactive fragments is approximately 40% of the administered dose. There may be a delay in the excretion of enoxaparin sodium in elderly patients as a result of a decrease in renal function with age. There was a decrease in the clearance of enoxaparin sodium in patients with reduced renal function. After repeated subcutaneous administration of 40 mg enoxaparin sodium once a day, there is an increase in anti-Xa activity, represented by the area under the pharmacokinetic curve in patients with insignificant (creatinine clearance 50-80 ml / min) and moderate (creatinine clearance 30-50 ml / min) impaired renal function. In patients with severe renal impairment (creatinine clearance less than 30 ml / min), the area under the pharmacokinetic curve at equilibrium is on average 65% higher with repeated subcutaneous administration of 40 mg of the drug once a day. In overweight people with subcutaneous administration of the drug, the clearance is somewhat less. If the dose is not adjusted for the body weight of the patient, then after a single subcutaneous injection of 40 mg of enoxaparin sodium, anti-Xa activity will be 50% higher in women weighing less than 45 kg and 27% higher in men weighing less than 57 kg compared with patients with normal average body weight.

Indications for use

Contraindications

Carefully use under the following conditions:

When using the drug for prophylactic purposes, the following correction of the dosing regimen is recommended

Influence on the ability to drive vehicles and engage in other potentially hazardous activities
The drug Clexane ® does not affect the ability to drive vehicles and mechanisms.

Release forms

Solution for injection 2000 anti-Xa IU / 0.2 ml; 4000 anti-Xa IU/0.4 ml; 6000 anti-Xa IU/0.6 ml; 8000 anti-Xa IU/0.8 ml; 10000 anti-Xa IU/1 ml.
1 type of packaging
0.2 ml or 0.4 ml or 0.6 ml or 0.8 ml or 1.0 ml of the drug solution in a glass syringe (type I), respectively. 2 syringes in a blister. On 1 or 5 blisters together with the application instruction in a cardboard pack.
2 type of packaging
0.2 ml or 0.4 ml or 0.6 ml or 0.8 ml or 1.0 ml of the drug solution in a glass syringe (type I) with a needle protection system, respectively. 2 syringes in a blister. On 1 or 5 blisters together with the application instruction in a cardboard pack.

Storage conditions

At a temperature not higher than +25°С. Keep out of the reach of children!

Best before date

3 years.
After the expiration date, the drug can not be used.

Holiday conditions

On prescription.

Registration certificate holder
SANOFI-AVENTIS FRANCE, France.

Manufacturer

1) Sanofi Winthrop Industry, France.
Manufacturer's address: 180, rue Jean Jaurès, 94702 Maison Elfort Sedex, France.
2) Sanofi Winthrop Industry, France.
Manufacturer's address: Boulevard Industrial, Zon Industrial, 76580 Le Trais, France.

Consumer claims should be sent to:
125009, Moscow, st. Tverskaya, 22.

Pregnancy is a very important time in every woman's life. It would seem that nature has calculated all the nuances and features of the work of the organs during the period of expectation of the baby, but in some cases a well-functioning system can fail. It is at these moments that it is important to quickly determine the diagnosis and help the body cope with the problem. Pharmacology offers a large selection of medicines, including Clexane. Why would a doctor recommend its use?

Clexane is a drug that has an antithrombotic effect. The therapeutic effect in the course of treatment is achieved due to the active substance - enoxaparin sodium. On the shelves of pharmacy chains, the drug arrives in disposable syringes, inside which contains liquid for injection. The doctor selects only the dosage. Manufacturers produce Clexane in 1.0 ml, 0.8 ml, 0.6 ml, 0.4 ml or 0.2 ml of a clear or yellowish solution.

It is worth noting that syringes are for single use only. You can not use them for the introduction of other drugs or Clexane repeatedly. After the procedure, the system must be disposed of.

Clexane comes in syringes that can't be reused.

Getting into the body by subcutaneous injection, the active substance reaches its full concentration in the blood after three, a maximum of five hours. Enoxaparin sodium is excreted, including by the kidneys.

During the period of expectation of a baby, women are forbidden to independently begin treatment with Clexane. This is due to the fact that a sufficient number of studies have not been conducted, so doctors cannot say with certainty whether the active ingredient penetrates the placental barrier. However, doctors, based on clinical observations of pregnant women who used the drug, do not note its negative impact on the development and health of the fetus.

Indications for the use of Clexane during pregnancy

From the moment of conception, significant changes occur in the body of a pregnant woman. First of all, it concerns blood formation. Many women know that blood volume increases, because it should be enough for a growing fetus. But not everyone knows about the increase in its coagulability: this is a kind of insurance for a woman in labor, preventing bleeding during childbirth. Nature has carefully planned everything. However, these factors increase the load on the circulatory system, which in some cases leads to the expansion of the walls of blood vessels, the onset of the inflammatory process, and in the future - to the development of thrombosis.

Fatigue, swelling of the legs, pain - all these are the first signs of varicose veins, which can provoke the formation of blood clots in the vessels

During the period of gestation, women must pass tests. If, according to the results of the study, hypercoagulability (a strong increase in blood clotting) is determined in the expectant mother, she is prescribed medications that help thin the vital fluid and prevent the formation of blood clots.

Blood clots are dangerous not only for the health of the mother. They can also form in the vessels of the placenta, which leads to impaired blood circulation between the body of the woman and the fetus: the blood flow slows down or stops altogether. Because of this, the child lacks oxygen and nutrients. This situation is extremely dangerous, because it negatively affects the development of the crumbs, and can also cause its intrauterine death.

Doctors prescribe treatment for expectant mothers with Clexane injections in the following cases:

• prevention and treatment of thrombosis (including to prevent the formation of blood clots in women who have been in bed for a long time);
• thrombosis after surgery;
• angina pectoris - acute chest pain that occurs due to insufficient blood supply to the heart;
• heart attack - a pathological condition due to circulatory disorders.

How long can a doctor prescribe Clexane

The decision on the possibility of including Clexane in the treatment regimen is made only by the doctor. In the first three months of pregnancy, doctors try not to prescribe injections to expectant mothers. This is due to the fact that there is no data on the effect of the active substance on the embryo. In the early stages, it is extremely important to minimize the risks of developing baby pathologies, because it is during this period that the formation of all organs and systems of the child takes place.

According to the instructions, the drug is undesirable for pregnant women. However, in practice, doctors often prescribe it starting from the second trimester. But the treatment takes place under the supervision of a doctor who carefully monitors the mother's health and studies changes in blood counts.

The growing uterus not only compresses the woman's internal organs, but also increases the pressure on the veins. As a result, inflammation of the walls of blood vessels and the formation of blood clots occur. Clexane is intended to prevent thrombus formation in the pelvic area and lower extremities.

How to give injections

The method of administration of Clexane differs from the usual. The fact is that the drug is forbidden to inject intramuscularly or intravenously. According to the instructions, the injection is made deep under the skin in the left and right abdomen in turn. The dosage is determined only by the doctor, depending on the diagnosis of the expectant mother and the individual characteristics of the course of pregnancy. Most often, women in anticipation of a baby are prescribed a daily dose, which is 0.2-0.4 ml of a solution.

Instructions for insertion under the skin on the abdomen

To correctly introduce the drug into the body, you must adhere to the following recommendations.

For convenience, doctors advise performing the procedure in the supine position. The course of treatment is also determined by the attending physician. On average, it is 7-14 days.

How to cancel the drug: stop abruptly or gradually

Cancellation of Clexane before childbirth has its own characteristics. In some situations, they throw it abruptly (for example, with a threat of miscarriage and bleeding). But in most cases, this should be done gradually and under the supervision of a doctor, slowly reducing the dosage and conducting regular blood tests. Before a planned cesarean section, the use of the drug is usually stopped the day before the operation, and after that several more injections are made to prevent the formation of blood clots.

A specialist will tell you about all the intricacies of Clexane cancellation.

Contraindications and side effects, as well as possible consequences for the child

Clexane is a serious medicine that has a fairly extensive list of contraindications. It is forbidden to inject the solution into the body of a woman if she has one or more conditions:

• allergic reactions to the components of the drug, which is a manifestation of individual intolerance to the active substances;
• risk of bleeding: the threat of abortion, hemorrhagic stroke (rupture of a cerebral vessel with subsequent hemorrhage), aneurysm (protrusion of the artery wall due to its thinning or stretching);
• hemophilia is a hereditary disease characterized by a violation of the blood coagulation process;
• the presence of an artificial valve in the heart.

In addition to these contraindications, there are a number of diseases in which Clexane must be used with great care:

• stomach ulcer or erosive mucosal lesions;
• severe forms of diabetes;
• disruption of the kidneys or liver;
• extensive open wounds (to avoid the development of serious bleeding).

Treatment with Clexane takes place under the supervision of a doctor in order to assess the condition of the woman and the fetus

During or after administration, the solution may cause unpleasant symptoms. Women should know that when they occur, you should not do another injection. It is necessary to seek advice from your doctor in order to change the drug or adjust the dose of the drug. The expectant mother may experience the following side effects:

• headaches, dizziness;
• allergic reactions: irritation, rash, itching;
• with prolonged use of Clexane, the development of cirrhosis of the liver is possible;
• hematomas at the injection site.

Simultaneous use with other drugs

It is forbidden to use Clexane together with other drugs that affect blood clotting processes, for example, Curantyl or Dipyridamole. With some groups of medicines, for example, non-steroidal anti-inflammatory drugs, anticoagulants (inhibit blood clotting) and thrombolytics (dissolve blood clots), Clexane is not used so as not to provoke bleeding.

What are the analogues and other options for replacing Clexane

There are other medications based on enoxaparin sodium on the pharmacological market, so pharmacists can offer a replacement. Full analogues of Kseksan are:

If, as a result of treatment with Clexane, a woman experiences unpleasant symptoms or she has contraindications to its use, the attending physician will select another drug. Have a similar therapeutic effect:

• Fraxiparine - the active substance is effective for the treatment and prevention of blood clots;
• Warfarin - is available in the form of blue tablets and is used while waiting for a child only in the second and third trimesters;
• Fragmin - solution for injection has an antithrombotic effect.

Gallery: Fraxiparine, Warfarin, Gemapaksan and other drugs used to treat blood clots

Fragmin is prescribed to pregnant women for the treatment of thrombosis.
Warfarin is forbidden to use in the first trimester of pregnancy Fraxiparine is available as a solution for injection.

Anfibra is available in several dosages. Gemapaksan is used to thin the blood and fight thrombus formation.

Table: characteristics of drugs that can be prescribed to pregnant women to replace Clexane

Name	Release form	Active substance	Contraindications	Use during pregnancy
	solution in ampoules	dalteparin sodium	immune thrombocytopenia; trauma or surgery of the central nervous system, eyes or ears; heavy bleeding; allergy to the components of the drug; arterial hypertension; kidney and liver diseases.	The drug can be used during pregnancy, the risk of complications for the fetus is minimal. However, it persists, so the medicine should be injected only on the advice of a doctor.
	tablets	warfarin sodium	the first trimester of pregnancy and the last 4 weeks of gestation; manifestation of high sensitivity to the components of the agent or suspicion of hypersensitivity; acute bleeding; severe diseases of the liver and kidneys; acute DIC; thrombocytopenia; lack of proteins C and S; varicose veins of the digestive tract; arterial aneurysm; increased risk of bleeding, including hemorrhagic disorders; duodenal ulcer; severe wounds, including postoperative; lumbar puncture; bacterial endocarditis; malignant hypertension; intracranial hemorrhage; hemorrhagic stroke.	The substance quickly crosses the placenta and causes birth defects between 6 and 12 weeks of gestation. During the period of bearing a baby and during childbirth, it can provoke bleeding. Warfarin is not prescribed in the first trimester, as well as in the last 4 weeks before the baby is born. At other times, use only when absolutely necessary.
	solution for injection in syringes	nadroparin calcium	bleeding or its increased risk associated with deterioration of hemostasis; thrombocytopenia with the use of nadroparin in the past; organ damage with a risk of bleeding; severe renal failure; intracranial hemorrhage; trauma or surgery on the spinal cord, brain or eyeballs; acute infective endocarditis; hypersensitivity to the components of the drug.	Animal experiments have not shown a negative effect of calcium nadroparin on the fetus, however, in the first 12 weeks of pregnancy, it is preferable to avoid the appointment of Fraxiparine, both in a prophylactic dose and in the form of a course treatment. During the II and III trimesters, it can only be used in accordance with the doctor's recommendations for the prevention of venous thrombosis (when comparing the benefits to the mother with the risk to the fetus). Course treatment during this period is not used.

For the prevention of 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, should be used only under medical supervision.

Composition and form of release

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

As an auxiliary component, the composition of the solution includes water for injection. The active ingredient is the low molecular weight sodium enoxaparin. The dosage of 1 syringe is measured in international units of anti-XA ME and is:

Syringe volume	Dose of anti-HA ME

Properties of the drug components

The drug belongs to the group of low molecular weight anticoagulants of the heparin class. Clexane has a high anti-Xa activity and a relatively low ability to inhibit thrombin. The mechanism of the pharmacological action of the drug is the activation of protein antithrombin, which slows down the activity of factor X, while not having a significant effect on platelet synthesis.

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

Why is Clexane prescribed?

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

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

How to inject Clexane

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

	Dosage	Multiplicity of introduction	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 with an average risk of blood clots		1 time / day
Patients at high risk of blood clots		1-2 times / day

special instructions

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

• In the event of a feeling of numbness or tingling of the extremities, impaired tactile sensations, in case of bowel disorder or bladder dysfunction, it is necessary to stop using Clexane and immediately consult a doctor.
• The drug does not have a significant effect on the psychomotor abilities of a person. You can drive a car or take part in work with increased concentration of attention throughout the course of therapy.
• Subject to the dosages and frequency of use indicated in the instructions, the drug does not affect the synthesis of platelets and the time of hematopoiesis.
• During therapy, it is necessary to regularly take a blood test in order to monitor and detect possible bleeding in time.
• From days 15 to 21 of therapy, the patient has an increased chance of developing thrombocytopenia (a condition characterized by a decrease in the number of platelets). If the treatment was prescribed for a course of more than 10 days, it is necessary to monitor the blood counts and compare them with the initial data of the laboratory examination.
• Patients with problems of the liver, kidneys, elderly people should consult a doctor to adjust the treatment regimen.

drug interaction

Instructions for use Clexane warns that the drug is strictly forbidden to combine or alternate with other low molecular weight heparins. During treatment, it is important to consider the following ability of the injection solution to interact with other medicines:

• 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 non-steroidal anti-inflammatory drugs (NSAIDs) increases the risk of hemorrhage (bleeding).
• Antihistamines, cardiac glycosides, smoking, tetracycline antibiotics reduce the effectiveness of Clexane.
• Simultaneous administration of low molecular weight heparins and anticonvulsants, antiarrhythmic drugs or beta-blockers leads to a decrease in the effectiveness of the latter.

Clexane and alcohol

The simultaneous use of the solution with alcoholic or alcohol-containing drinks is strictly prohibited. Ignoring this instruction can lead to increased side effects, liver failure, hemorrhagic apoplexy (sudden paralysis due to rupture of the arteries and bleeding in the brain).

Side effects

The drug Clexane increases the risk of bleeding, especially when taking other drugs that affect hemostasis at the same time. If blood flow disorders are detected, the medication should be stopped immediately. Other side effects of Clexane include:

Organ or system
		Headache.
Hematopoiesis	Hematoma, epistaxis, thrombocytopenia.	Intracranial hemorrhage, retroperitoneal bleeding.
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 more than 3 months).
Skin and soft subcutaneous tissues	Inflammation, swelling at the injection site, soft tissue hardening.	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 an overdose, the patient is shown the slow introduction of a neutralizing substance - protamine sulfate. One milligram of this drug completely inhibits the effect of 1 mg of enoxaparin. The introduction 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 physician. 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 by an increased risk of bleeding - abortion, threatened miscarriage, aortic aneurysm, hemorrhagic stroke;
• children's age (up to 18 years);
• the presence of artificial heart valves in the patient's body.

With caution, injections are prescribed to elderly patients, people with liver or kidney disease. Other relative contraindications include:

• pathologies that are accompanied by a violation of hemostasis - hemophilia, severe vasculitis, thrombocytopenia, hypocoagulation;
• erosive and ulcerative lesions of the gastrointestinal tract;
• recent ischemic stroke;
• complicated diabetes mellitus;
• recent childbirth, ophthalmic or neurological surgery;
• performance of spinal, epidural anesthesia;
• performing a spinal puncture;
• 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 the prescription. Store Clexane, according to the instructions, at temperatures up to 25 ° C. Shelf life - 3 years.

Analogues

In the absence of Clexane in the pharmacy, the doctor may prescribe other drugs with an identical principle of action. Analogues with the same active ingredient are:

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

Fraxiparine or Clexane - which is better

With individual intolerance to enoxaparin sodium, drugs with similar pharmacological properties, but with a different active substance, are prescribed. An analogue of Clexane based on calcium nadroparin - Fraxiparin. The drug has the same list of indications, contraindications, side effects. Detailed comparative studies between Clexane and Fraxiparine have not been conducted, so the choice of the preferred drug should be made by the doctor.

Clexane price

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

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