Clexane® in pregnancy

General information about Clexane®

Clexane® is the trade name of a drug with the active ingredient enoxaparin. This belongs to the group of low molecular weight heparins and is supposed to inhibit blood clotting by inhibiting the activity of a coagulation factor (factor Xa).

Clexane® is used for Prophylaxis of thrombosis, for the therapy of thromboses and Pulmonary embolism and to Anticoagulant for other indications (e.g. Atrial fibrillation). Usually Clexane® is prescribed in a dosage of 0.4 ml for thrombosis prophylaxis before and after operations.
The pre-filled syringe can be applied under the skin by the patient himself.
A dreaded side effect are Bleeding. It can also cause the Platelets come.

Medication in Pregnancy

In general, with all medications during pregnancy you should always weigh up with the gynecologist whether these medications are absolutely necessary and whether they have any effects on the unborn child.
If this is the case, an attempt should be made to replace the drug with a better tolerated preparation.
It should also be noted that most drugs have not been tested in pregnant women, so there is always uncertainty about the safety of most drugs in pregnancy. Nonetheless, there are databases of retrospectively observed drug side effects in pregnant women.

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Use of Clexane® during pregnancy

In summary, one can say that Clexane® and other low molecular weight heparins are well tolerated during pregnancy and no unwanted side effects demonstrate.
There are only a few good studies on the subject of Clexane® pregnancy, but it can also be assumed from animal studies that the substance does not pass onto the unborn child, this is especially true from the 13th week of pregnancy.
If you are pregnant, the indication for anticoagulant therapy with Clexane® should be made very narrow.

Clexane® is used during pregnancy for the following indications:

  • Treatment of Thrombosis in Pregnancy
  • Use in artificial heart valves (note: especially Marcumar for blood thinning is absolutely contraindicated during pregnancy)
  • Prevention of birth complications with known coagulation disorders

A Epidural anesthesia for pain therapy of pregnant women during childbirth may under therapy with Clexane 40® not done as the risk for one Bleeding into the spinal canal increased with constriction of the spinal cord.

Even with possible Caesarean section If possible, this should not be done under therapy with Clexane 40®. Here it is advisable to at least suspend the dose on the day of the surgical delivery. Also should be the next gift no earlier than 12 hours after the operation respectively.

What dosage do I need: 20, 40 or more mg?

The dosage of Clexane® during pregnancy depends on the individual circumstances. Whenever possible, attempts are made to prevent any medication being given during pregnancy. If this is not possible, the dose level will be adapted to the need and possibility. The motto here is: as high as necessary and as low as possible. The recommended dose of Clexane® can change during pregnancy. Regular blood tests can determine how much of the active ingredient is needed. In particular, if the pregnant woman cannot or is allowed to move less for various reasons, a higher dosage may be necessary. Often times, a dose adjustment is indicated at the end of pregnancy. In some cases a very high dose of 80 mg may be advisable. It is also important to skip Clexane® towards delivery. This means that if you are planning a cesarean section, the last injection with the active substance should be made at least 12 hours before the operation. If there is an unplanned caesarean section, the procedure is based on the obstetric situation and the last administration of Clexane®. For patients who are at high risk of thrombosis or who are receiving high-dose prophylaxis, switching to what is known as unfractionated heparin can be useful. In these cases, it is recommended to change the active ingredient in the 36th week of pregnancy or at the latest when labor has started regularly. The last unfractionated heparin is given 4 hours before birth. As a rule, Clexane® is restarted 6-12 hours after birth in an individual dose. If a spinal cord anesthesia is required during delivery, the last dose of Clexane® must be 10-12 hours ago. The next dose should be administered 2-4 hours later in an adjusted dose.

What are the side effects?

The side effects of Clexane® correspond to the general side effects of the preparation. There are also a few special features that should be taken into account. When the risk-benefit ratio is well balanced, the side effects are minor. A big advantage is that Clexane® does not cross the placental barrier. This means there are no side effects for the unborn child. As a precaution, however, it should be mentioned that in some cases, according to studies, Clexane® may be less suitable for pregnant women.According to studies, treatment with Clexane® carries the risk of clot formation in pregnant women with artificial heart valves. This can lead to a blockage in the heart valve and thus to death. In addition, using Clexane® for several months during pregnancy can contribute to bone loss. This means that the active ingredient can increase the risk of developing what is known as osteoporosis. The risk is greater if there is already a predisposition to developing osteoporosis or if an unhealthy lifestyle is preferred. The risk is correspondingly smaller if the opposite is the case. Individual advice and treatment from the attending gynecologist should be sought.

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