On physical examination of a newly admitted case of bedridden elderly patient I noticed circular red patches around 3-4 cm radius over right and left lateral thighs. I  recognised it as the local damage due to the improper administration of Injection Clexane, a subcutaneously administered antithrombotic, which is a Low Molecular Weight Heparin. This led me to the thought,” How can we administer inj clexane properly?”. ” How safely we are administering it daily?”. In this post, I will share my knowledge about inj Clexane and the recommendations for its safe administration.

WHAT IS INJ CLEXANE?

It is an Antithrombotic.

The active ingredient of Inj Clexane is Enoxaparin Sodium. It is a low molecular weight heparin (LMWH).

LMWH is produced by chemically splitting heparin into one-third of its original size. Has fewer side effects than heparin and has more predictable anticoagulant action. 

THERAPEUTIC INDICATIONS

• Prophylaxis of Venous thromboembolic diseases in Surgical patients(orthopaedic and general surgeries) and in Medical patients(rheumatic disease)
• Treatment of DVT and Pulmonary Embolism (PE)
• Acute STEMI
• Unstable Angina and NSTEMI
• In Haemodialysis – To prevent thrombus formation in Extracorporeal Circulation

CONTRAINDICATIONS

• Active significant bleeding
• Hypersensitivity
• Thrombocytopenia
• Vascular aneurysms
• Oesophageal varices
• Hyperkalemia

SIDE EFFECTS

• Haemorrhage
• Haematoma
• Anaemia
• Ecchymosis
• Confusion
• Diarrhoea
• Haematuria

DRUG INTERACTIONS

• Aspirin
• NSAIDs
• Dextran
• Warfarin

Interaction with these drugs increase the risk of bleeding

NURSING CONSIDERATIONS

METHODS OF ADMINISTRATION

Should NOT BE  administered by IM route. IM CAUSES HAEMATOMA.

Preferred injection method is subcutaneous

In special cases, IV routes are used

TECHNIQUE FOR SAFE S/C ADMINISTRATION

• Patient must be preferably in a lying position.
• DO NOT expel the air bubble from the syringe. {This is to avoid the loss of drug while using prefilled syringes}
• PREFERRED SITE: The subcutaneous tissue of the anterolateral or posterolateral ABDOMINAL WALL
• It is administered as a DEEP S/C INJECTION
• The whole length of the needle should be introduced PERPENDICULARLY, not from sides, into the skinfold gently held between the thumb and the index finger. SKINFOLD SHOULD BE HELD THROUGHOUT THE INJECTION

 

• DO NOT rub the injection site after administration

IV BOLUS ADMINISTRATION (Only for Acute STEMI)

• Initiate the treatment with single dose IV bolus injection, followed by  s/c injection
• For IV, Multidose Vials or Prefilled syringes can be used

 

 

• IV administration should not be mixed or coadministered  with any other medications
• Safely administered with NS (normal saline .9%) solution or 5%D in water.

MONITORING AND SAFETY IMPLICATIONS

• Lab monitorings include

Baseline coagulation studies: aPTT, PT, INR, clotting time

periodic CBC for blood counts

periodic urine and stool examination for occult blood

• apply direct pressure for venipuncture site for long durations
• Assess for any history of allergy for the patient
• Monitor for any signs of side effects

PATIENT TEACHING

• Educate regarding the increased risk of bleeding while taking inj clexane, monitoring for bleeding and management of bleeding
• Instruct not to take any OTC medications without the consultation of the doctor
• Patients who will self-administer it must be instructed on correct s/c administration technique
• Instruct not to breastfeed while taking inj clexane

Let us join hands for safe administration of antithrombotics, to ensure the full benefit of the therapy with minimal potential harm.