Clexane (Enoxaparin)

[laurabuk]

Hi All,

I've just started a hospital placement this week, today was my first day on a ward with a Pharmacist: a lot of the patients, particularly the elderly and the surgical wards were being prescribed Clexane prophylatically - apparently most patients who are admitted for more than a few days are prescribed this for 'protection' against the development of clots. I wanted to know is this a common thing or is it just special to the Trust I am working in? Any information on this would be great, as I've never come across this drug before.

Laura

[johannes]

It's a common thing. Here everyone gets it.
Some patients do not tolerate heparin, they devellop a HAT or HIT. For those Argatroban can be used for example.
Some have renal problems and better get adjustable unfractionated heparin.

[johnep]

Clexane, Fragmin and Innohep are all low molecular weight heparins which have a very long half life compared to standard heparin. heparin has to be given continously IV and therefore means pt has to be admitted, whereas LMW heps can be given SC and even self administerd. Also reduced is the risk associated with IV such as MRSA etc.
johnep

[Steve G]

The LMWH have predictable pharmacokinetics, therefore you can dose according to weight. When I did my hospital experience they had tables everywhere with what dose of fragmin to use for which weight.

[laurabuk]

Hi!

Thanks thats great - this is my first hospital placement, so I've never come across this before.

Laura

[New pharmacist]

Hi just wondering if anyone had come across an orally administered dosage form of enoxaprin recently. I received a prescription while working locum one sunday writter for enoxapam. I asked around but no other pharmacists I know had ever dispensed a product of that name but one pharmacist told me she thought she had seen an advetisement in MIMMS(Ireland) recently. Anyone heard of a product by that name then?

[lamzee]

It sounds like a junior doctor who can't spell enoxaparin to me. There is a new oral product by Bayer called Xarelto 10mg (rivaroxaban) advertised in MIMS Ire as "new hip new knee new choice". It is an oral direct factor Xa inhibitor.

[New pharmacist]

I rang the hospital and it was a consultant that wrote the prescription. H e wasn't working so i couldnt talk to him

[paul2008]

There are two new oral anticoagulants on the market, one is dabigatran (pradaxa(R) ) the other is as listed above but possibly not in use in the Uk yet. Please refer to section 2.8.2 of the BNF. These drugs are being promoted as the oral alternative to enoxaparin/detaparin/tinazpain.



Regarding their routine use in medical patients, this follows a 2005? report in parilment detailing a alarming death rate due to thrombosis in patients discharged from hospital. You can explore more here (Department of health website)

[New pharmacist]

Thanks for the info Ill look into it