Clexane in early and late pregnancy: why prescribed?

What do you need to know about using the drug Clexane during pregnancy? During the period of bearing a child, the expectant mother may face a variety of health problems that she did not know about before pregnancy. Thus, a blood test sometimes indicates that a woman has too thick blood: this problem can greatly harm both the course of pregnancy itself and the developing baby, and in the female body the risk of developing thrombosis, heart attacks and strokes increases sharply.

Is it safe to administer Clexane? Who needs this drug, and who can do without it?

Clexane when planning pregnancy

Even at the stage of pregnancy planning, a woman is recommended to analyze her blood for the quality of blood clotting - to do the so-called hemostasis analysis. Based on its results, it is possible to prevent the development of complications, and the woman will be able to conceive and carry a child to the due date.

A coagulogram is mandatory:

• women who have a family history of heart attacks, strokes, thrombosis, varicose veins (or if the woman herself has such a problem);
• if the patient has already had an unsuccessful pregnancy that ended in miscarriage or frozen pregnancy;
• if a woman is actively involved in sports, or has problems with the digestive, endocrine system, or metabolism.

If the potential mother-to-be does not belong to any of the risk groups, the doctor can still send her for testing - at his discretion. Before assisted reproductive technology procedures (IVF, ICSI, IISM), a blood clotting test is carried out in any case.

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Can Clexane be used during pregnancy?

The formation of blood clots is a huge danger during pregnancy. One of the most common risks is the blockage of blood vessels. Such a pathology can become a problem not only for the growing fetus, which may develop oxygen starvation, but also for the expectant mother. In such a situation, the likelihood of spontaneous termination of pregnancy, pregnancy fading, as well as heart attacks and strokes increases significantly. Pregnancy fading occurs due to impaired blood circulation in the endometrium, and at the same time the supply of nutrients to the fetus suffers. In addition, due to such a disorder, it becomes difficult for the embryo to gain a foothold.

To avoid the listed problems, a doctor may prescribe Clexane to pregnant women: many patients carry a baby without complications only thanks to this drug. However, Clexane is not prescribed during pregnancy "just like that": for this, there must be appropriate indications.

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Indications Clexane in pregnancy

Not in all cases is it possible to solve the problem of excessively thick blood by correcting nutrition and lifestyle. When thickening is a threat to the fetus or expectant mother, the doctor will rush to prescribe medications, taking into account the coagulogram indicators and the condition of the pregnant woman.

In general, Clexane is used to prevent the development of hypercoagulation syndrome. During pregnancy, a woman's body experiences a physiological increase in blood clotting. This happens in the most natural way: nature has provided for this in order to minimize blood loss during labor.

If such a physiological phenomenon during pregnancy does not go beyond the norm, then the appointment of Clexane will not be required. After the baby is born, the woman's hemostasis system returns to the normal indicators that were before pregnancy. Things are different if coagulation disorders go beyond the established limits. In such a situation, it is necessary to prescribe medications to thin the blood and reduce the likelihood of thrombus formation. This is where Clexane is needed, or similar in action representatives of low molecular weight heparins.

A special indication for the use of Clexane during pregnancy is thrombophilia - a disease that is accompanied by increased thrombus formation in the vessels (more - in the veins). Often, thrombophilia is diagnosed precisely during gestation, when the third placental circle of blood circulation is formed in the female body. The patient's degree of coagulation increases, thrombi form in the vascular lumen, which block the placental-uterine and placental-fetal network. Blockages prevent normal blood supply to the fetus, which begins to experience a deficiency of oxygen and nutrients. Clexane for thrombophilia helps to "break up" thrombi in a timely manner and prevent their formation.

Such pathologies as uterine hematomas also require special medical supervision. Their formation may be associated with severe toxicosis, high blood pressure, injuries and physical exertion, as well as with hemophilia, thrombophilia, and metabolic disorders. The appearance of a hematoma may affect the development of the embryo. In addition, premature placental abruption may begin. Prescribing Clexane for a hematoma in the uterus during pregnancy helps thin the blood, improves the quality of nutrition of the fetus, and prevents hypoxia.

The benefits of Clexane for intrauterine fetal development are in many cases beyond doubt. Therefore, many expectant mothers are interested in: does it make sense to administer Clexane for prophylaxis during pregnancy? Indeed, some gynecologists rush to prescribe the drug at the slightest doubt, even in cases where the woman's hemostasis indicators are within normal limits. However, most doctors are unanimous in their opinion: Clexane should be used only in cases of obvious need. If such a need is "illusory", then it is better to pay attention to other, more gentle methods of optimizing the quality of blood clotting.

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Release form

Clexane is a direct-acting anticoagulant. It is produced as a solution for subcutaneous injection, which is packaged directly into syringes of different volumes. A cardboard box contains five blister plates with a pair of syringe-doses in each plate. One syringe-dose has a needle with a special protective system. The solution is transparent, colorless, or with a slightly yellowish tint.

The active component is enoxaparin. One milliliter of solution contains 10 thousand anti-Xa IU, which is equivalent to 100 mg of sodium enoxaparin.

Clexane 0.2, 0.4, 0.6, 0.8 and 1 ml contain the active component 20, 40, 60, 80 and 100 mg, respectively.

Water for injections acts as an auxiliary component.

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Pharmacodynamics

The active ingredient of Clexane belongs to low-molecular heparins, with independent antithrombotic and anticoagulant activity. Clexane has a high ratio of anti-Xa to anti-IIa activity. This ratio is equal to 3.6. Clexane has the following positive properties:

• reduces the activity of coagulation factor IIa;
• increases bioavailability;
• has predictable anticoagulant capacity;
• improves glomerular filtration;
• accompanied by a low frequency of antibody production;
• osteoblasts are activated slightly.

Clexane is effective when administered subcutaneously and has a long half-life. The therapeutic effect occurs when the medication is administered once a day. Treatment with Clexane is characterized by a low incidence of thrombocytopenia and osteoporosis.

To date, medical professionals have no reliable information that the active component of Clexane during pregnancy overcomes the placental membrane. Unfortunately, the studies necessary for this have not yet been conducted. Experiments conducted on animals do not always fully reflect the true picture that occurs in the human body.

However, in clinical practice, there is not a single case registered where any negative consequences for the child would develop if its mother was injected with Clexane during pregnancy. Key points: the medication should be prescribed strictly according to indications, in the minimum possible dosage, with constant monitoring of the quality of blood clotting.

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Pharmacokinetics

After subcutaneous injection, the active component of Clexane is fully absorbed (almost 100%). The maximum possible level of activity in the serum is noted after 3.5 hours. Steady-state concentration is determined already on the second day from the start of treatment.

Within the recommended dosage range, the kinetic properties of Clexane are linear. The drug concentration is predictable and within the therapeutic range.

The distribution of anti-Xa activity is close to 5 liters (almost the volume of human blood).

The half-life of anti-Xa activity exceeds that of unfractionated heparins. Elimination is monophasic, with a half-life of about 4 hours after a single subcutaneous injection, and about 7 hours after repeated injections.

The active component and metabolites are excreted via the kidneys and hepatobiliary system. Renal clearance of elements with anti-Xa activity may be about 10% of the amount of the administered drug. Total renal excretion is 40% of the dose.

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Dosing and administration

The drug Clexane is available in different volumes, because the doctor sets the dosage individually, depending on the patient's test results. Most often, injections of the drug are performed at a dose of 40 mg daily, once a day, for 2 weeks or more.

In case of deep venous pathology, the dosage of Clexane during pregnancy is determined by weight: the amount of the drug is calculated based on the ratio of 1.5 mg/kg of the woman’s weight.

A common question: where can Clexane be injected during pregnancy? Injections are given subcutaneously, in the abdominal area, namely, in the right or left segment, at least five centimeters away from the umbilical point. Injections are given alternately, sometimes in the right, sometimes in the left segment.

There should be no doubt where to inject Clexane in late pregnancy. The medication is administered exclusively into the abdominal area, observing all the necessary conditions and rules.

First, carefully read the instructions on how to properly inject Clexane into the abdomen during pregnancy:

1. Wash your hands with soap or treat them with a disinfectant. The patient lies down on a bed or couch.
2. The area for the injection is presumably marked.
3. The intended injection site is treated with a cotton pad soaked in alcohol.
4. Carefully remove the cap from the needle connected to the syringe filled with Clexane. The syringe is completely ready for use. Do not press on the piston protrusion to remove air bubbles, as this may disrupt the dosage of the drug. The needle is sterile and should not touch anything until the solution is completely injected.
5. The skin on the abdomen is taken in a thick fold using the index finger and thumb of the free hand. Important: the fold must be held during the entire period of administration of the medication.
6. The syringe is held so that the needle is directed downwards (vertically) and is inserted into the fold to its full length.
7. Press the piston protrusion with your thumb, inject the drug, and hold the fold with your other hand.
8. The needle is removed from the skin without changing the angle. The skin fold is released.
9. Point the syringe with the needle downwards and away from you, press the piston protrusion until it stops: this action should activate the installation of the protective cover. Then the syringe should be thrown away.

The injection site must not be rubbed, kneaded, or lubricated with creams or gels.

The usual frequency of administration of the drug is daily, once a day. Intermittent injections of Clexane every other day during pregnancy are undesirable, as this disrupts the stable state of hemostasis.

• It is not advisable to prescribe Clexane in the first trimester of pregnancy for the prevention or treatment of blood thickening. The clinical information that specialists have is not enough to determine the likelihood of an adverse effect of the drug on the fetus or the course of pregnancy itself. If a doctor prescribes Clexane during early pregnancy, he or she should especially carefully weigh all the risks, resorting to the help of the drug only in case of real need.
• Clexane in the 2nd trimester of pregnancy can be prescribed for therapeutic purposes, since there is a clinical possibility of using the drug without teratogenic or fetotoxic effects. However, additional studies are required before using Clexane: the drug is prescribed only if other similar drugs are ineffective.
• Clexane may be prescribed in the 3rd trimester of pregnancy if blood clotting indicators indicate the need for such a step. In most cases, the drug is used up to 36 weeks, but for individual patients, treatment may be continued at the discretion of the doctor.

There is no need to be afraid to use Clexane in late pregnancy if your doctor insists on it. If necessary, the drug is administered until the day of delivery, if possible, stopping it 12 hours before the onset of labor.

It is advisable to perform injections daily at the same time, with an acceptable range of ± 1 hour.

What to do if you missed a Clexane injection during pregnancy? Missing one injection should not negatively affect the state of hemostasis, but it is advisable to do the following injections on time and regularly.

The doctor decides how much to inject and how to stop taking Clexane during pregnancy. In some cases, the medication is stopped abruptly, in others, it is gradually replaced with another drug. This issue is decided on an individual basis, because everything depends on the blood counts and the state of the patient's coagulation system.

It is also possible to temporarily discontinue Clexane during pregnancy if the doctor sees the need for it. Such discontinuation should be monitored by a hematologist and accompanied by appropriate blood tests.

Contraindications

Your doctor will not prescribe Clexane during pregnancy if:

• if there is a threat of spontaneous termination of pregnancy against the background of an increased risk of bleeding;
• in diagnosed vascular and aortic aneurysms;
• if the patient has suffered a stroke (ischemic or hemorrhagic);
• if the patient suffers from hypertension;
• in severe stages of diabetes mellitus;
• in case of renal failure;
• in case of liver failure;
• if a woman has artificial heart valves.

It is not recommended to administer Clexane after the 36th week of pregnancy, however, this issue is decided on an individual basis: in some cases, the use of the drug is possible until childbirth and even for some time after the birth of the child.

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Side effects Clexane in pregnancy

The most common and dangerous side effect of Clexane treatment is bleeding of varying degrees. That is, even if a woman notices minor bloody discharge during pregnancy that occurs during treatment, it is necessary to stop administering the drug and immediately consult a doctor.

More severe bleeding from Clexane during pregnancy is possible with an incorrectly selected dosage, in the absence of control over the state of the blood coagulation system, when the drug is prescribed without adequate indications.

In isolated cases, hemorrhagic syndrome was observed, with intracranial and retroperitoneal hemorrhages. The use of Clexane with simultaneous epidural anesthesia may lead to the formation of a hematoma in the spinal cord space.

A frozen pregnancy on Clexane is not a consequence of treatment with this drug, and may only indicate the presence of other factors that could lead to complications.

Allergy to Clexane during pregnancy often manifests itself with local symptoms:

• pain in the area where the medication was administered;
• swelling, redness;
• formation of a bruise, compaction.

In some cases, systemic reactions may also be detected (including an inflammatory process in the vascular walls).

Side effects such as thrombocytopenia or increased transaminases are of no particular clinical significance and are always temporary.

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Overdose

Accidental over-administration of Clexane may cause dangerous hemorrhagic complications. That is why treatment with the drug is always carefully monitored by a hematologist.

If an overdose does occur, a kind of antidote to Clexane is often used – we are talking about protamine sulfate: to neutralize 1 mg of Clexane, the doctor should administer the same amount of protamine. If more than eight hours have passed since the last administration of Clexane, the dosage of the antidote can be reduced: 0.5 mg of protamine per 1 mg of Clexane will be required. If the last injection of Clexane occurred more than twelve hours ago, there is no need to use the antidote.

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Interactions with other drugs

Experts note that some combinations of medications with Clexane can accelerate the development of hyperkalemia. Among such drugs are potassium salts, potassium-sparing diuretics, agents that inhibit angiotensin-converting enzyme or angiotensin II receptors, nonsteroidal anti-inflammatory and heparin-containing drugs, as well as Trimethoprim, Cyclosporine and Tacrolimus.

Hyperkalemia does not develop in all patients, but only in those who take the indicated medications simultaneously.

Clexane and Curantil are often prescribed together during pregnancy: against the background of blood thinning, the growth and development of the fetus improves, which receives more nutrients and oxygen. However, such combined treatment must be monitored regularly by a hematologist.

Clexane should not be combined with drugs that inhibit fibrinolysis. For example, the simultaneous use of Tranexam and Clexane is generally inadvisable.

During pregnancy, Clexane combines well with angioprotectors and capillary stabilizing drugs. Often you can find such a combination as Phlebodia 600 and Clexane: during pregnancy, this combination allows you to increase the tone of the capillaries, improve venous outflow and lymphatic drainage.

Aspirin paired with Clexane significantly increases the risk of bleeding: platelet function is suppressed, the digestive system is affected. In addition, taking acetylsalicylic acid during pregnancy is generally contraindicated: if it is necessary to achieve an antipyretic effect, it is preferable to use Paracetamol (Panadol, etc.).

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Storage conditions

Syringe doses are stored in the original packaging and box, in places protected from direct sunlight and children's access. The optimal storage temperature is up to 24-25°C. The medicine must not be frozen or heated.

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Shelf life

The package with Kleksan is stored for up to 3 years from the date of production. An opened syringe should be used immediately: it cannot be stored.

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Analogues

Clexane is a fairly expensive medication. However, you should not look for analogues based on cost-saving issues: other drugs representing the group of low-molecular heparins have a weaker effect, which may not be enough to ensure adequate blood clotting.

If the coagulogram indicators slightly exceed the normal range, then in this case the initial use of analogues is not excluded. Clexane is prescribed only when similar drugs do not justify themselves and do not have the desired effect. What analogues are we talking about:

• Fraxiparin is a drug based on calcium nadroparin, has antithrombotic activity and is often used in preparation for pregnancy.
• Gemapaxan, Novoparin, Flenoks, Ekleksiya are enoxaparin-based drugs, so they can be called complete analogues of Clexane. However, the replacement of such medications must be approved by a doctor, since there are many nuances and risks that arise only during the clinical use of these drugs.
• Fragmin is a drug represented by the active component dalteparin. It can be used in the form of subcutaneous and intravenous infusions.

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Doctors' reviews

If the doctor considers it appropriate to prescribe Clexane during pregnancy, it is hardly worth discussing this prescription - especially in cases where tests indicate a tendency to form blood clots. Treatment with the drug is carried out only under constant medical supervision, observing all the subtleties of administration and dosage of the solution.

Despite possible side effects, the benefits of Clexane are more than noticeable: this medication is irreplaceable when it comes to the threat of bearing a fetus, or to developmental disorders associated with pathological thickening of the blood.

During treatment, a woman should definitely and regularly take a blood test to monitor the quality of coagulation. Such measures are necessary, since based on the results, the doctor can draw conclusions about the effectiveness of Clexane during pregnancy, as well as monitor the possibility of complications and assess the likelihood of risks.

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