Vistarin

Indications

Enoxaparin Sodium is a blood thinner (anticoagulant) given by injection. It is used to:

• prevent blood clots in the veins (deep vein thrombosis) after surgery, especially hip or knee replacement and abdominal surgery, and in patients confined to bed with serious illness;
• treat existing clots in the legs (deep vein thrombosis) or lungs (pulmonary embolism);
• treat some types of heart attack and unstable angina, together with other heart medicines;
• stop blood clotting in the machine during kidney dialysis.

How It Works

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

Dosage and Administration

Enoxaparin is given as an injection under the skin of the tummy, usually by a doctor or nurse. Some patients are trained to inject themselves at home. In heart attack treatment and dialysis it may also be given into a vein in hospital.

The dose depends on the reason for use, body weight and kidney function, and is always as prescribed by your doctor. Do not change the dose or stop early without advice.

For self-injection: do not expel the air bubble from a pre-filled syringe, inject into a pinched fold of skin on alternate sides of the tummy, and do not rub the site afterwards.

Interactions

The risk of bleeding is higher with other medicines that affect clotting, such as Warfarin, Aspirin, Clopidogrel, other antiplatelet medicines and painkillers like Ibuprofen and Diclofenac (NSAIDs). Some medicines, such as Spironolactone or ACE inhibitors, can raise blood potassium together with Enoxaparin. Tell your doctor about all medicines and herbal products you take.

Contraindications

• Active major bleeding or a condition with high bleeding risk, such as a recent bleed in the brain
• Past heparin-induced thrombocytopenia (a serious drop in platelets caused by heparin) within the last 100 days
• Allergy to Enoxaparin, heparin or pork products
• Spinal or epidural anaesthesia within 24 hours of treatment doses

Side Effects

Common: bruising, pain or a small lump at the injection site, minor bleeding (such as nosebleeds or bleeding gums), and changes in liver tests. Long-term use may thin the bones.

Get medical help at once for any serious bleeding: black or bloody stools, blood in urine, vomiting blood, coughing blood, a severe headache, sudden weakness or confusion. Also seek urgent help for back pain, numbness or leg weakness after a spinal or epidural injection, a severe allergic reaction, or a painful, darkening skin area around the injection site.

Pregnancy and Lactation

Enoxaparin does not cross the placenta and is widely used in pregnancy when a doctor decides it is needed. Only a very small amount passes into breast milk and it is not absorbed by the baby's gut, so it can usually be used while breastfeeding.

Precautions and Warnings

• Your doctor may check platelet counts, kidney function and potassium during treatment.
• Extra care is needed in kidney disease, low body weight, the elderly, uncontrolled high blood pressure, stomach ulcers and liver disease.
• Tell any doctor or dentist that you use Enoxaparin before surgery, spinal anaesthesia or tooth extraction.
• Do not inject into muscle.

Overdose

Overdose can cause serious bleeding. Seek emergency care at once. In hospital, Protamine Sulfate may be given to partly reverse the effect.

Therapeutic Class

Anticoagulant (low molecular weight heparin).

Storage

Store below 30°C, away from light and out of the reach of children. Do not freeze.