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]

Re: Clexane (Enoxaparin)

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]

Re: Clexane (Enoxaparin)

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]

Re: Clexane (Enoxaparin)

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]

Re: Clexane (Enoxaparin)

Hi!

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

Laura

[New pharmacist]

Re: Clexane (Enoxaparin)

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]

Re: Clexane (Enoxaparin)

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]

Re: Clexane (Enoxaparin)

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]

Re: Clexane (Enoxaparin)

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]

Re: Clexane (Enoxaparin)

Thanks for the info Ill look into it

[Rafael]

Re: Clexane (Enoxaparin)

please enlighten us what was the outcome?

not sure about clexane, but some products(injections) can be emptied in a cup and given orally as an off license drug.

[Moosa]

Re: Clexane (Enoxaparin)

From a doctor's point of view, I can confirm that prophylactic clexane is very commonly used in patients who have reduced mobility, the most common dose being 40mg s/c od, although 20mg is more likely in the case of frail elderly patients. You might also see "CLEXANE + TEDS" written on the drug chart, which reminds nurses to ensure the patient is wearing TED stockings, which also reduce incidence of DVT.

It's very rare for doctors to prescribe IV heparin nowadays, because it's a headache to ensure levels in the bloods, for instance it often involves the night medics having to take a patient's blood at 4am to measure APTT ratio. A practical example when iv heparin would be clinically indicated is: patient has confirmed pulmonary embolus, and suspected GI bleed. In this case, heparin would have a big advantage over enoxaparin, because you could stop the heparin with immediate effect if the patient becomes haemodynamically unstable.

Dabigatrin is a direct thrombin inhibitor, I've only seen one patient on it, he was taking it as part of a clinical trial. I don't think it's licensed in the UK yet, it's certainly not in common use in the UK. Currently there's not really a good oral alternative for warfarin, which is a great shame because of course warfarin is a hugely problematic drug with all the issues surrounding P450 inhibition/potentiation by a whole list of medications including alcohol.

[Nik]

Re: Clexane (Enoxaparin)

I believe dabigatran etexilate (Pradaxa) is licensed in UK. Rivaroxaban is the other rival anticoag on the market.

[starhammad]

Re: Clexane (Enoxaparin)

Enoxaparan is nothing....& Heparin and related compounds can't be taken orally, as they are amino acids and destroyed by gastric acids.
Regards,

[jennimay]

Re: Clexane (Enoxaparin)

What would be the result of taking rivaroxaban and having subcut clexane?