Enoxaparin

Enoxaparin belongs to a group of medications known as anticoagulants. It may be used to prevent existing clots from worsening, or to prevent clots from forming due to acute illness or prolonged immobilisation.

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​What is this medication used for​

Enoxaparin belongs to a group of medications known as anticoagulants. It may be used to prevent existing clots from worsening, or to prevent clots from forming due to acute illness or prolonged immobilisation.

Enoxaparin is prescribed because 

  • Patient has been diagnosed with blood clot(s) in the leg(s) / lung / heart / others, or
  • ​Patient has undergone major surgery which requires prolonged immobilization and it is necessary to prevent blood clots in the leg(s) 

​​​

Dosage and How to Use​

​​​The dose of enoxaparin is usually based on your weight if used to treat clots. Your doctor or pharmacist will decide how long you should be on enoxaparin. Do not stop using the injection without first speaking with your doctor or pharmacist.​


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Patients should be sitting or lying down and CLEXANE® (enoxaparin sodium) injection administered by subcutaneous injection. Select an area on the right or left side of your abdomen at least 5 cm away from your belly button. Clean the area you have selected for your injection, and allow to dry.

Do not inject yourself within 5 cm (2 ins) of your belly button or near scars or bruises. Remember to rotate injection sites.
​2

​Carefully remove the needle cap by firmly pulling it straight off the syringe and discard the needle cap.
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​Gently pinch the cleansed area of the abdomen between your thumb and index finger to make a fold in the skin. 

Do not expel the air bubble inside the injection

Insert the full length of needle at a 90° angle into the skin fold held between the thumb and forefinger; inject Clexane slowly, pushing the plunger to the bottom of the syringe. 

The skin fold should be held throughout the injection. To minimize bruising, do not rub the injection site after injection is complete.


​4 ​Remove the needle from injection site, keeping your finger on the plunger. As you take out the needle, let go of the skin fold. 
During this step you can release pressure on the plunger.

​5​Immediately dispose of the syringe in the nearest sharps collector. Alternatively, you may adapt a hard container (e.g. milo tin or detergent bottle) for use as a sharps collector.​

Missed a​ Dose​

Inject the missed dose as soon as you remember. If it is close to the time for your next dose, skip the missed dose and go back to your normal time. Do not inject two doses at the same time.

Side Effects, Precautions, Contraindication​​​

What precautions do I need to take?​​

Enoxaparin may increase the risk of bleeding and bruising. Some warning signs to look out for include nosebleeds, heavy menstruation, and gum bleeding. It may be necessary to switch to a soft-bristled toothbrush. Should you experience these side effects, please inform your doctor or pharmacist as soon as possible.

​Examine yourself daily for any bruises and pin-sized blood spots under the skin. Do not massage any bruises. 

Certain contact sports and activities like rugby and martial arts e.g. karate/judo, should be avoided as they can put you at greater risk of injuries and bruising.

Should you be scheduled for any invasive procedures e.g. operations / surgery or dental procedures, check with your doctor to see if there is a need to stop enoxaparin. 

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What are some of the side effects of this medication?

  • ​Pain on injection site  (You should rotate injection sites to prevent this)
  • Mild bruising at the injection site 
  • ​Extensive bruising on the abdomen or site of injection may mean you are not injecting it correctly. Please call your pharmacist or doctor for medical advice if you observe extensive or worsening bruises.

These are not all the side effects that can occur. If you have questions about the side effects of enoxaparin, ask your doctor or pharmacist.


Handling and Storage​​

Keep the injections in a safe place out of reach of children. Store the injections in a dry place at room temperature, away from heat and direct light. Do not store in a refrigerator or freezer. Used syringes should be disposed of appropriately.


When to seek further medical advice​

Look out for signs of allergy: swelling of lips and/or eyes, difficulty breathing, rashes or itching. Stop the medication and see your doctor immediately if it occurs.

In addition, please consult your doctor immediately should you suspect you are pregnant. You should also consult your doctor before becoming pregnant or deciding to breastfeed. 

Go to the A&E immediately if you experience the following:

  • Coffee-grain like appearance of vomit;
  • Dark, cloudy or “Teh-O”-coloured urine;
  • Dark, tarry, and foul-smelling stools;
  • Extensive bruising or hard impact(s) occurring to any part of your body;
  • Severe bleeding that does not stop despite application of continuous pressure for more than 15 minutes;
  • Sudden shortness of breath;
  • Increased frequency of chest tightness or chest pains;
  • Sudden blurred vision (“blackouts”), severe headaches with nausea and vomiting or memory lapses;​
  • Numbness and/or weakness over one side of your body;
  • Sudden development of red, swollen, warm and painful lower limb(s)

It is important that you have sufficient supply to last until your next appointment unless instructed otherwise. If you realise that you are running out of supply before your appointment, either bring forward your appointment or call up the hospital to request for a further prescription for more medication to last until your appointment date.


​Additional Information​​

What are the strengths of enoxaparin injections available?​

The brand name for enoxaparin is Clexane®. There are three different strengths available:​​
​                                                                                                                              

40mg/0.4ml: Ye​llow ​syringe

60mg/0.6m​l: Ora​nge​ s​yringe

​​80mg/0.8ml:​​​​​ Bro​wn syringe


Prepared by KTPH Patient Education Workgroup 08.05.17
The information provided in this article is intended to supplement, not as a substitute for, the expertise and judgment of your doctor, pharmacist or any other healthcare professional. 


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