Klexane (Enoxaparin Sodium)

Klexane, a low molecular weight heparin, is used in several thromboembolic conditions.

• Deep vein thrombosis (post‑surgical): Prevents clot formation in patients after surgery.
• Acute deep vein thrombosis: Treats existing clots to restore venous patency.
• Pulmonary embolism: Facilitates clot resolution and reduces mortality in acute cases.
• Haemodialysis: Prevents circuit clotting during renal replacement therapy.
• Acute coronary syndromes: Provides antithrombotic protection in unstable angina or myocardial infarction.

• Enoxaparin sodium binds to antithrombin III, enhancing its inhibitory activity against activated factor X (FXa) and, to a lesser extent, factor IIa (thrombin). This accelerated inhibition reduces thrombin generation and fibrin formation, thereby interrupting the coagulation cascade and limiting clot propagation in the venous and arterial systems. The selective inhibition of FXa provides a more predictable anticoagulant response compared with unfractionated heparin, allowing for fixed dosing in many clinical protocols.

Enoxaparin may cause a range of adverse reactions, from mild to severe.

Common Side Effects

• Injection site bruising: Localized discoloration at the injection site.
• Minor bleeding: Nosebleeds, gum bleeding, or easy bruising.
• Nausea: Transient gastrointestinal upset.

Serious or Rare Side Effects

• Major bleeding: Gastrointestinal, intracranial, or surgical site hemorrhage.
• Thrombocytopenia: Heparin‑induced platelet count reduction.
• Spinal/epidural hematoma: Bleeding in the spinal canal after neuraxial procedures.

When using Klexane, several precautions should be observed.

• Renal impairment: Adjust dose or monitor anti‑Xa activity in patients with reduced kidney function.
• Elderly patients: Increased bleeding risk; use lowest effective dose.
• Concomitant anticoagulants: Avoid combining with other anticoagulants unless clinically justified.
• Recent surgery or trauma: Assess bleeding risk before initiating therapy.
• Pregnancy: Use only if potential benefit outweighs risk to the fetus.
• Store below 25°C: Keep in original packaging, protect from moisture and light.

Enoxaparin can interact with other medicines, requiring careful management.

Major Interactions (Avoid)

• Other anticoagulants (e.g., warfarin, direct thrombin inhibitors): Heightened risk of severe bleeding.
• Antiplatelet agents (e.g., aspirin, clopidogrel): Additive anticoagulant effect increasing hemorrhage.
• NSAIDs (e.g., ibuprofen, naproxen): Potentiate bleeding tendency.

Moderate Interactions (Monitor Closely)

• Renal function modifiers (e.g., aminoglycosides): May alter enoxaparin clearance.
• Thrombolytic therapy (e.g., alteplase): Combined effect can increase bleeding.
• SSRIs or SNRIs: May modestly increase bleeding risk; monitor patient.