Monitoring

Normally, monitoring of anticoagulation levels of Clexane® is not required [46]. In general, because response to Clexane® at usual doses is consistent from patient to patient, the anticoagulant response to enoxaparin does not need to be monitored. LMWHs have a predictable dose-response relationship and Clexane® has a half-life that permits once- or twice-daily dosing. This facilitates simple fixed or weight-based dosing, enabling outpatient treatment in appropriate cases without the need for routine monitoring. This is reflected in the Summary of Product Characteristics [46].

Platelet count monitoring

As there is a risk of antibody-mediated heparin-induced thrombocytopenia occurring with low molecular weight heparins, regular platelet count monitoring should be considered prior to and during therapy with these agents. Thrombocytopenia, should it occur, usually appears between the 5th and the 21st day following the initiation of therapy. Therefore, it is recommended that the platelet counts be measured before the initiation of therapy with Clexane® and then regularly thereafter during the treatment. In practice, if a confirmed significant decrease of the platelet count is observed (30 to 50 % of the initial value), enoxaparin sodium treatment must be immediately discontinued and the patient switched to another therapy [46].