Klexane (Enoxaparin Sodium)

• Enoxaparin sodium is a low molecular weight heparin used in the prevention and treatment of venous thromboembolism.
• Deep vein thrombosis: prevention and treatment of DVT in surgical and medical patients.
• Pulmonary embolism: treatment of acute PE and prevention of recurrence.
• Venous thromboembolism prophylaxis: prophylaxis after orthopedic or abdominal surgery.
• Anticoagulation during hemodialysis: provides anticoagulation for patients undergoing haemodialysis.
• Acute coronary syndromes: adjunct anticoagulant therapy in ACS management.

• Enoxaparin binds to antithrombin III, markedly enhancing its inhibition of factor Xa and, to a lesser extent, factor IIa (thrombin). This reduces thrombin generation and fibrin formation, thereby interrupting the coagulation cascade and preventing clot propagation in the venous system.

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

Common Side Effects

• Injection site bruising or pain.
• Minor bleeding such as epistaxis or gum bleeding.
• Nausea or mild gastrointestinal discomfort.
• Headache.
• Transient elevation of liver enzymes.
• Local erythema at the injection site.

Serious or Rare Side Effects

• Major hemorrhage, including intracranial or gastrointestinal bleeding.
• Heparin‑induced thrombocytopenia (HIT).
• Allergic reactions such as rash, urticaria, or anaphylaxis.
• Spinal or epidural hematoma following neuraxial procedures.
• Severe hypotension.
• Skin necrosis at the injection site.

• Before initiating enoxaparin therapy, several safety considerations are essential.
• Renal impairment: adjust dose or monitor anti‑Xa activity in patients with reduced kidney function.
• Bleeding risk: assess for active bleeding or high‑risk lesions prior to use.
• Pregnancy: category B; use only when the clinical benefit outweighs potential risk.
• Surgery or invasive procedures: discontinue appropriately before major operations to reduce bleeding.
• Concomitant anticoagulants: avoid combined use with other anticoagulants unless clinically indicated.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze.

Enoxaparin can interact with other medicines, affecting bleeding risk or anticoagulant effect.

Major Interactions (Avoid)

• Concurrent unfractionated heparin: additive anticoagulation increases bleeding.
• Combined warfarin therapy: potentiates anticoagulant effect and raises INR.
• Use with potent antiplatelet agents (e.g., clopidogrel) in high‑bleeding‑risk patients.

Moderate Interactions (Monitor Closely)

• NSAIDs (ibuprofen, naproxen): may increase minor bleeding.
• Thrombolytic agents (alteplase, streptokinase): additive anticoagulant effect.
• SSRIs or SNRIs (fluoxetine, venlafaxine): potential for increased bleeding tendency.