Clexane

• Low molecular weight heparin (LMWH)
  • Lower protein binding = More predictable dose response
    • Main types used in NZ:
      • Enoxaparin (Clexane): fragments of 2000 to 8000 daltons
      • Dalteparin (Fragmin): mean molecular weight 4,500 daltons
• MOA
  • Enhancing the activity of antithrombin III
  • Leading to inhibition of specific clotting factors, primarily Factor Xa and, to a lesser extent, Factor IIa (thrombin).
  • 4-6 hour t1/2
• Dose
  • Depends on indication
  • Safe in pregnancy
• Considerations
  • OD vs BD dosing
• Perioperative Mx
  • Withhold the dose day before procedure
• Reversal of Heparin (& LMWH)
  • Protamine: 1mg for 100U heparin, maximum of 50mg
  • For clexane 1mg protamine for each 1mg of clexane
  • Only 60% of the anti-Xa activity is neutralised
  • Short half-life so may need to repeat