Clexane

The ONE-STEP safety syringe

Clexane is the only low-molecular weight heparin (LMWH) in the UK with a one-step automatic safety syringe, which helps to minimise the risk of needlestick injury1-6.

With the CLEXANE needle protection system, there is less reliance on the user for activation after injection versus other available LMWH syringes.

The sheath automatically deploys once the syringe has been emptied pressing the plunger all the way down.

For more information about how to use the Clexane syringe click on the link below to visit the About Clexane section

Dosing

Different dosages of Clexane® are recommended for the different therapeutic indications1. Enoxaparin is available as convenient colour-coded pre-filled syringes and as multi-dose vials.


When using Clexane, colour alone should not be used to distinguish syringes – always read labels carefully

Mechanism of action

Clexane® exerts its anticoagulant effect by preventing the formation of blood clots through binding to antithrombin, a naturally occurring coagulation inhibitor and potentiating its action8.

Antithrombin is a natural inhibitor of the coagulation factors FXIa, FIXa, FXa and FIIa (thrombin)8.

Clexane® forms a complex with antithrombin. This complex undergoes a conformational change; in its altered conformation, the complex inhibits FXa, which is the primary mechanism of action. It also inhibits FIIa, although to a lesser extent - in vitro, Clexane has a high anti-Xa activity and low anti-IIa or anti thrombin activity, with a ratio of 3.67.

The pharmacodynamic profile of enoxaparin, like other LMWHs, has advantages over unfractionated heparin (UFH). These include8:

  • Minimal plasma binding, leading to more reliable anticoagulant effects and eliminating the need for therapeutic monitoring.
  • A greater capacity to release tissue factor pathway inhibitor and hence the generation of FVIIa.
  • A lower propensity to inhibit platelet aggregation.
  • Less inhibition by platelet factor 4.
  • Potential antiplatelet effects via higher degrees of suppression of von Willebrand factor
  • Less propensity to cause heparin-induced thrombocytopenia and osteoporosis.

Indication

Clexane® is an anticoagulant of the low-molecular-weight heparin (LMWH) class, derived from natural porcine heparin1.

Clexane is indicated in adults for7:

  • The prophylaxis of venous thromboembolism (VTE)
    • In moderate and high risk surgical patients, in particular those undergoing orthopaedic or general surgery including cancer surgery.
    • In medical patients with an acute illness and reduced mobility at increased risk of VTE.
  • The treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), excluding PE likely to require thrombolytic therapy or surgery.

Clexane is indicated in adults for7:

  • Prevention of thrombus formation in extracorporeal circulation during haemodialysis.
  • Acute coronary syndrome:
    • Treatment of unstable angina and Non ST-segment elevation myocardial infarction (NSTEMI), in combination with oral acetylsalicylic acid.
    • Treatment of acute ST-segment elevation myocardial infarction (STEMI) including patients to be managed medically or with subsequent percutaneous coronary intervention (PCI).

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References

  1. Clexane Patient Information Leaflet, September 2020.
  2. Fragmin Graduated Syringe 10,000 IU/ml Summary of Product Characteristics, October 2020.
  3. Innohep Patient Information Leaflet, December 2019.
  4. Tinzaparin Patient Information Leaflet, September 2020.
  5. Inhixa Patient Information Leaflet, December 2020.
  6. Arovi Patient Information Leaflet, November 2018.
  7. Clexane Pre-filled Syringes Summary of Product Characteristics. May 2020. Please consult the SmPC for full information.
  8. Carter NJ, McCormack PL, Plosker GL. Enoxaparin: a review of its use in ST-segment elevation myocardial infarction. Drugs 2008; 68:691–710.

MAT-GB-2100351 (v1.0) March 2021