Intravax

Indications

Enoxaparin is an injectable blood thinner. It is used to:

• Prevent blood clots in the legs or lungs after surgery (such as hip or knee replacement) and in patients who are confined to bed because of illness.
• Treat deep vein thrombosis (a clot in a leg vein) and pulmonary embolism (a clot in the lungs).
• Treat unstable angina and certain types of heart attack, together with other medicines.
• Prevent clotting in the tubing during kidney dialysis.

How It Works

Enoxaparin is a low molecular weight heparin. It boosts antithrombin, a natural substance in the blood, which then blocks clotting factors (mainly factor Xa). This stops new clots from forming and stops existing clots from growing, while the body slowly dissolves them.

Dosage and Administration

Enoxaparin is given by injection under the skin of the stomach area, usually by a doctor or nurse; some patients are trained to inject it themselves at home. In hospital it can also be given into a vein. The dose depends on the reason for treatment, body weight and kidney function, so it is always as prescribed. Do not expel the air bubble from a prefilled syringe before injecting, and do not rub the site afterwards. Use a different site each time.

Interactions

The risk of bleeding is higher with other medicines that affect clotting, such as Aspirin, NSAID painkillers (Ibuprofen, Diclofenac), Clopidogrel, Ticagrelor, Warfarin, Rivaroxaban, Apixaban, Dabigatran and other heparins, and with steroid tablets and some antidepressants (such as Fluoxetine). Medicines that raise potassium, such as Spironolactone and ACE inhibitors, need extra monitoring. Tell your doctor about every medicine you take.

Contraindications

• Allergy to enoxaparin, heparin or pork products.
• Active major bleeding, or a condition with a high risk of bleeding (such as a recent brain bleed or active stomach ulcer).
• Heparin-induced thrombocytopenia (a drop in platelets caused by heparin) within the past 100 days.
• Spinal or epidural anaesthesia within 24 hours when treatment doses are used.

Side Effects

Common: bruising, pain, redness or a small lump at the injection site, minor bleeding (nose or gums), and changes in blood tests (liver enzymes, platelets). Less common: high potassium, rash and itching.

Get urgent medical help if you have any sign of serious bleeding (blood in urine, black or bloody stools, vomiting blood, coughing up blood, a severe headache, or heavy bleeding that will not stop), numbness or weakness in the legs or back pain after a spinal or epidural injection, a new painful swollen leg or sudden breathlessness, or signs of a serious allergic reaction.

Pregnancy and Lactation

It does not cross the placenta and is commonly used in pregnancy when a specialist decides it is needed, as prescribed. Multi-dose vials containing benzyl alcohol should be avoided in pregnancy. It can be used while breastfeeding.

Precautions and Warnings

Your doctor may check blood counts, platelets, potassium and kidney function. Extra care is needed in older people, people with kidney problems, low body weight, high blood pressure, liver disease or a history of stomach ulcers. Tell every doctor and dentist that you are on a blood thinner, especially before any procedure. Do not switch between heparin products without medical advice.

Overdose

Too much can cause serious bleeding. This is a medical emergency; go to hospital straight away. Protamine can partly reverse its effect.

Therapeutic Class

Anticoagulant (low molecular weight heparin).

Storage

Store below 25°C (or as stated on the pack), away from light and out of the reach of children. Do not freeze.