Klexane (Enoxaparin)
Low Molecular Weight Heparin for Blood Clot Prevention and Treatment
Quick Facts About Klexane
Key Takeaways About Klexane
- Essential anticoagulant: Klexane (enoxaparin) is widely used in hospitals and at home to prevent deep vein thrombosis, pulmonary embolism, and complications of heart attacks
- Self-injectable: Patients can learn to self-inject Klexane subcutaneously into the abdomen, making outpatient treatment convenient and effective
- Bleeding is the main risk: The most significant side effect is bleeding, which occurs in more than 1 in 10 patients – seek immediate medical attention for any unusual bleeding
- Dose adjustment in kidney disease: Patients with severe renal impairment (creatinine clearance <30 ml/min) require reduced doses to prevent drug accumulation
- Not interchangeable with other LMWHs: Do not substitute Klexane with other low molecular weight heparins (nadroparin, tinzaparin, dalteparin) as they have different potencies and dosing instructions
What Is Klexane and What Is It Used For?
Klexane contains enoxaparin sodium, a low molecular weight heparin (LMWH) that prevents blood from clotting. It is used to treat existing blood clots and to prevent new clots from forming in a wide range of clinical situations, including surgery, immobility, heart attacks, and haemodialysis.
Klexane belongs to a class of medicines called low molecular weight heparins, which are derived from standard (unfractionated) heparin through a controlled depolymerisation process. This produces smaller heparin fragments with a more predictable pharmacological profile. Enoxaparin exerts its anticoagulant effect primarily by binding to antithrombin III (AT III), a naturally occurring protein in the blood. This binding dramatically accelerates the ability of antithrombin III to inactivate clotting Factor Xa, which is a key enzyme in the coagulation cascade responsible for converting prothrombin to thrombin.
Compared with unfractionated heparin, enoxaparin has a higher ratio of anti-Xa to anti-IIa activity (approximately 3.8:1), meaning it more selectively targets Factor Xa while having a relatively smaller effect on thrombin. This selective mechanism provides a more predictable dose-response relationship, improved bioavailability after subcutaneous injection (approximately 100%), and a longer half-life that allows once- or twice-daily dosing. These pharmacological advantages have made LMWHs the standard of care over unfractionated heparin in most clinical settings.
Indications for Use
Klexane is prescribed for the following purposes:
- Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE): Klexane dissolves and prevents the growth of existing blood clots in the veins, particularly in the legs (DVT) and lungs (PE). It is often used as initial treatment while oral anticoagulants such as warfarin reach therapeutic levels.
- Prevention of blood clots during and after surgery: Patients undergoing major orthopaedic surgery (hip or knee replacement), abdominal surgery, or other procedures with increased thrombotic risk receive prophylactic doses of Klexane to prevent post-operative DVT and PE.
- Prevention of blood clots during illness-related immobility: Hospitalised patients with acute medical conditions (such as heart failure, severe respiratory disease, or infections) who are confined to bed receive Klexane to reduce the risk of venous thromboembolism.
- Cancer-associated thrombosis: Klexane is used to prevent recurrent blood clots in cancer patients, who have a significantly elevated thrombotic risk due to the prothrombotic effects of malignancy and chemotherapy.
- Unstable angina and heart attacks: In acute coronary syndromes – both NSTEMI (non-ST-elevation myocardial infarction) and STEMI (ST-elevation myocardial infarction) – Klexane is administered alongside aspirin and other antiplatelet agents to prevent further clot formation in the coronary arteries.
- Prevention of clotting in haemodialysis circuits: Klexane is added to the arterial line at the start of dialysis sessions to prevent blood from clotting inside the extracorporeal tubing.
Enoxaparin was first approved for medical use in 1993 and is included on the World Health Organization's List of Essential Medicines, recognising it as one of the most effective and safe medicines needed in a health system. It is marketed under the brand names Klexane (Nordic countries), Clexane (UK, Germany, and many other countries), and Lovenox (USA, France). Despite the different names, all contain the same active substance: enoxaparin sodium.
What Should You Know Before Using Klexane?
Before starting Klexane, inform your doctor about all your medical conditions, especially any history of bleeding disorders, heparin-induced thrombocytopenia, kidney or liver disease, and any medications you are taking. Klexane is contraindicated in active major bleeding and known hypersensitivity to heparin or enoxaparin.
Contraindications
You should not use Klexane if any of the following apply to you:
- Allergy to enoxaparin, heparin, or other LMWHs (such as nadroparin, tinzaparin, or dalteparin) – signs of allergic reaction include rash, difficulty swallowing or breathing, and swelling of the face, lips, tongue, or throat
- History of heparin-induced thrombocytopenia (HIT) within the past 100 days, or if you have anti-heparin antibodies in your blood – HIT is a serious immune-mediated reaction that causes a dramatic drop in platelet count and paradoxically increases the risk of blood clots
- Active major bleeding or conditions with a high risk of uncontrolled haemorrhage – including active peptic ulcer, recent brain or eye surgery, recent haemorrhagic stroke, or known bleeding disorders
- Spinal or lumbar puncture, or epidural/spinal anaesthesia planned within 24 hours when receiving therapeutic doses of Klexane – the risk of spinal haematoma, which can cause permanent paralysis, is too great
- Benzyl alcohol-containing multi-dose vials must not be used in premature infants or neonates up to 1 month of age due to the risk of a fatal toxic reaction known as “gasping syndrome”
Patients receiving enoxaparin who undergo spinal/epidural anaesthesia or spinal puncture are at risk of developing a haematoma in the spinal canal. This can result in long-term or permanent paralysis. The risk increases with the use of indwelling epidural catheters, concomitant use of drugs that affect haemostasis (NSAIDs, platelet inhibitors, other anticoagulants), or traumatic or repeated punctures. If you are scheduled for spinal or epidural procedures, inform your doctor that you are using Klexane.
Warnings and Precautions
Talk to your doctor or pharmacist before using Klexane if you have or have had any of the following conditions:
- Previous reaction to heparin causing a significant decrease in platelet count – a blood test may be needed before starting treatment
- Prosthetic heart valve – there is limited experience with enoxaparin in patients with mechanical heart valves, and adequate anticoagulation may not be guaranteed
- Endocarditis (infection of the heart valves) – increased risk of haemorrhagic complications
- History of peptic ulcer disease – risk of gastrointestinal bleeding is increased
- Recent stroke – risk of haemorrhagic transformation
- Uncontrolled high blood pressure – increases the risk of bleeding complications
- Diabetes or diabetic retinopathy – bleeding into the eye is a potential risk
- Recent eye or brain surgery – increased bleeding risk at the surgical site
- Advanced age (especially over 75 years) – elderly patients have an increased risk of bleeding
- Kidney disease – enoxaparin is primarily excreted through the kidneys; impaired renal function leads to higher drug levels and increased bleeding risk; dose reduction is required when creatinine clearance is below 30 ml/min
- Liver disease – impaired synthesis of clotting factors may increase bleeding tendency
- Low body weight or obesity – dosing may need adjustment
- Elevated potassium levels – heparins can suppress aldosterone secretion, leading to hyperkalaemia, especially in patients with diabetes or renal impairment
Pregnancy and Breastfeeding
If you are pregnant, planning to become pregnant, or breastfeeding, speak with your doctor before using Klexane. Enoxaparin does not cross the placenta in significant amounts and is generally considered one of the safer anticoagulant options during pregnancy. However, pregnant women with prosthetic heart valves have an increased risk of thromboembolism even with adequate anticoagulation, and special monitoring is required.
The benzyl alcohol-containing multi-dose vial formulation should be avoided during pregnancy, as benzyl alcohol may cross the placenta. Pre-filled syringes that do not contain benzyl alcohol are the preferred formulation for pregnant women.
Small amounts of enoxaparin may pass into breast milk. If you are breastfeeding, your doctor will assess whether the benefits of treatment outweigh any potential risks to your infant. Current evidence suggests that the oral bioavailability of heparins in breast milk is very low, making significant absorption by the infant unlikely.
Blood Tests and Monitoring
Your doctor may order blood tests before and during treatment with Klexane to monitor:
- Platelet count – to detect heparin-induced thrombocytopenia (HIT), a serious immune-mediated reaction. Platelet monitoring is typically recommended before starting treatment and periodically during therapy, especially during the first few weeks.
- Potassium levels – heparins can suppress aldosterone production, leading to elevated potassium (hyperkalaemia), particularly in patients with diabetes, renal impairment, or those taking potassium-sparing medications.
- Anti-Xa levels – in specific populations (such as patients with severe renal impairment, very low or very high body weight, or pregnant women), monitoring of anti-Xa activity may be used to assess drug effect and guide dose adjustment.
Driving and Operating Machinery
Klexane has no known effect on the ability to drive or operate machinery. However, if you experience dizziness or other symptoms that may impair your concentration, avoid driving until the symptoms have resolved.
How Does Klexane Interact with Other Drugs?
Klexane interacts with several types of medications that affect blood clotting or potassium levels. The most clinically significant interactions involve other anticoagulants, antiplatelet agents, and NSAIDs, all of which increase the risk of bleeding when used together with enoxaparin.
It is essential to inform your doctor or pharmacist about all medicines you are currently taking, have recently taken, or might take, including over-the-counter medications and herbal supplements. The following medicines are particularly important to mention:
| Interacting Drug | Category | Effect | Clinical Advice |
|---|---|---|---|
| Warfarin | Vitamin K antagonist | Additive anticoagulant effect – significantly increased bleeding risk | Overlap therapy is common during bridging; close INR monitoring is required |
| Aspirin (ASA) | Antiplatelet / NSAID | Impaired platelet function increases bleeding risk | Often co-prescribed in ACS; benefits usually outweigh risks under medical supervision |
| Clopidogrel | Antiplatelet (P2Y12 inhibitor) | Additive inhibition of platelet aggregation | Used together in acute coronary syndromes; requires careful bleeding monitoring |
| Ibuprofen, Diclofenac, Ketorolac | NSAIDs | Impaired platelet function and potential GI mucosal damage increase bleeding risk | Avoid concurrent use if possible; if necessary, use lowest effective dose for shortest duration |
| Dextran injections | Plasma volume expander | Impaired platelet aggregation and dilution of clotting factors | Concurrent use should be avoided where possible |
| Prednisolone, Dexamethasone | Corticosteroids | Increased risk of gastrointestinal bleeding, especially with high-dose or long-term use | Monitor for signs of GI bleeding; consider gastroprotection |
| Potassium-sparing diuretics, ACE inhibitors, ARBs | Potassium-elevating drugs | Combined risk of hyperkalaemia (elevated potassium) | Monitor serum potassium regularly, especially in patients with renal impairment or diabetes |
Switching Between Anticoagulants
Switching between different types of blood-thinning medications requires careful timing to maintain effective anticoagulation while minimising bleeding risk. The approach depends on which medications are being switched:
- From Klexane to warfarin: Your doctor will ask you to take blood tests (INR) and will tell you when to stop Klexane. Both medications are typically given together (overlapping) until the INR reaches the therapeutic range (usually 2.0–3.0) on two consecutive measurements.
- From warfarin to Klexane: Stop the vitamin K antagonist. Your doctor will check your INR and instruct you when to start Klexane injections.
- From Klexane to a direct oral anticoagulant (DOAC): Stop Klexane and start the DOAC 0–2 hours before the time the next Klexane injection would have been due.
- From a DOAC to Klexane: Stop the DOAC and do not start Klexane until 12 hours after the last dose of the direct oral anticoagulant.
If you are scheduled for a spinal or lumbar puncture, or surgery requiring spinal or epidural anaesthesia, you must inform your doctor that you are using Klexane. Timing of the last dose before and the first dose after the procedure must be carefully planned to minimise the risk of spinal haematoma, a rare but serious complication that can lead to paralysis.
What Is the Correct Dosage of Klexane?
The dose of Klexane varies depending on the indication, body weight, kidney function, and age. It is given as a subcutaneous injection (under the skin), and in some cases as an intravenous injection. Klexane is usually administered by a healthcare professional, but patients can be trained to self-inject at home.
Always use Klexane exactly as your doctor has prescribed. The following dosage information is a general guide – your doctor will determine the most appropriate dose for your individual circumstances.
| Indication | Dose | Route | Duration |
|---|---|---|---|
| Treatment of DVT/PE | 150 IU/kg (1.5 mg/kg) once daily, or 100 IU/kg (1 mg/kg) twice daily | Subcutaneous | As determined by physician (typically 5–10 days, overlapping with oral anticoagulant) |
| Surgical thromboprophylaxis (moderate risk) | 2,000 IU (20 mg) once daily | Subcutaneous | First injection 2 hours before surgery; continue 7–10 days post-op |
| Surgical thromboprophylaxis (high risk) | 4,000 IU (40 mg) once daily | Subcutaneous | First injection 12 hours before surgery; continue up to 5 weeks (orthopaedic) |
| Medical illness prophylaxis | 4,000 IU (40 mg) once daily | Subcutaneous | 6–14 days (or until patient is mobile) |
| NSTEMI / unstable angina | 100 IU/kg (1 mg/kg) every 12 hours (+ aspirin) | Subcutaneous | Minimum 2 days; usually up to 8 days |
| STEMI (age <75) | 3,000 IU (30 mg) IV bolus, then 100 IU/kg (1 mg/kg) SC every 12 hours | IV + Subcutaneous | Up to 8 days or hospital discharge |
| STEMI (age ≥75) | 75 IU/kg (0.75 mg/kg) SC every 12 hours (no IV bolus; max 7,500 IU for first 2 doses) | Subcutaneous | Up to 8 days or hospital discharge |
| Haemodialysis | 100 IU/kg (1 mg/kg) into arterial line | Arterial line | Per dialysis session (usually 4 hours) |
Dose Adjustment in Kidney Disease
Enoxaparin is primarily eliminated through the kidneys. In patients with severe renal impairment (creatinine clearance below 30 ml/min), the drug accumulates in the body, significantly increasing the risk of bleeding. Dose reductions are mandatory in this population:
- Treatment doses: Reduce to 100 IU/kg (1 mg/kg) once daily instead of the standard twice-daily or higher once-daily dose
- Prophylactic doses: Reduce to 2,000 IU (20 mg) once daily instead of 4,000 IU (40 mg)
- Monitoring: Anti-Xa levels should be monitored to ensure appropriate anticoagulation and safety
Patients with mild to moderate renal impairment (creatinine clearance 30–80 ml/min) do not routinely require dose adjustment, although your doctor may choose to monitor anti-Xa levels in certain clinical situations.
How to Self-Inject Klexane
If your doctor has prescribed Klexane for home use, a healthcare professional will teach you the proper self-injection technique before you begin. Do not attempt to inject yourself without proper training. The steps below are a summary – always follow the specific instructions provided by your healthcare team.
Step-by-Step Self-Injection Guide
- Prepare the injection site: Choose an area on the left or right side of your abdomen, at least 5 cm from the navel and away from scars or bruises. Alternate between left and right sides for each injection.
- Clean the site: Wash your hands, then clean the injection area with an alcohol swab or soap and water. Do not rub.
- Remove the needle cap: Carefully remove the needle cap from the pre-filled syringe. Do not press the plunger to expel air bubbles, as this may cause loss of medication.
- Pinch a skin fold: Gently pinch a fold of skin between your thumb and index finger. Keep the fold pinched throughout the entire injection.
- Insert the needle: Hold the syringe like a pen and insert the full length of the needle at a 90-degree angle into the skin fold.
- Inject the medication: Press the plunger fully with your thumb to inject all the medication into the fatty tissue of the abdomen.
- Remove and dispose: Pull the needle straight out while keeping your fingers on the plunger. If your syringe has an automatic needle guard, it will activate as you withdraw. Dispose of the used syringe in a sharps container.
- Do not rub: To avoid bruising, do not rub or massage the injection site afterwards.
Missed Dose
If you forget to take a dose, administer it as soon as you remember. Do not take a double dose to compensate for a missed injection. Keeping a diary or setting reminders can help ensure you do not miss doses. If you are unsure what to do, contact your doctor or pharmacist for advice.
Overdose
If you think you have taken too much Klexane, contact your doctor, pharmacist, or poison control centre immediately, even if you do not have any symptoms. Accidental overdose with enoxaparin can lead to serious bleeding complications. The antidote is protamine sulfate, which partially neutralises the anticoagulant effect of enoxaparin. One mg of protamine sulfate neutralises approximately 100 IU (1 mg) of enoxaparin. However, even with protamine, the anti-Xa activity of enoxaparin is never completely neutralised (approximately 60% is reversed).
It is crucial that you continue using Klexane for the full duration prescribed by your doctor. Stopping treatment prematurely can lead to the formation of blood clots, which can be life-threatening. If you experience any side effects or have concerns, discuss them with your healthcare provider before discontinuing treatment.
What Are the Side Effects of Klexane?
Like all medicines, Klexane can cause side effects, although not everyone experiences them. The most common side effect is bleeding, which can range from mild bruising at the injection site to serious internal haemorrhage. Elevated liver enzymes are also very common but usually resolve on their own.
As with all anticoagulants, the primary risk associated with Klexane is bleeding. The risk of bleeding increases with higher doses, concomitant use of other medications that affect blood clotting, and in patients with conditions that predispose to haemorrhage. Contact your doctor immediately if you experience any bleeding that does not stop on its own, signs of excessive blood loss (unusual weakness, fatigue, pallor, dizziness, unexplained headache, or unexplained swelling), or any other symptoms that concern you.
Signs of a severe allergic reaction (rash, difficulty breathing or swallowing, swelling of the face, lips, tongue, or throat); signs of heparin-induced thrombocytopenia such as painful redness with dark red spots under the skin; widespread red scaly rash with bumps under the skin and blisters accompanied by fever (acute generalised exanthematous pustulosis).
Very Common
May affect more than 1 in 10 people
- Bleeding (from any site)
- Elevated liver enzymes (transaminases)
Common
May affect up to 1 in 10 people
- Bruising more easily than usual (thrombocytopenia)
- Pink or red spots on the skin, often at the injection site
- Skin rash (urticaria, hives)
- Itchy red skin
- Bruising or pain at the injection site
- Decreased red blood cell count (anaemia)
- Elevated platelet count (thrombocytosis)
- Headache
Uncommon
May affect up to 1 in 100 people
- Sudden severe headache (may indicate intracranial bleeding)
- Abdominal tenderness or swelling (may indicate internal bleeding)
- Large, irregular skin lesions with or without blisters
- Local skin irritation at the injection site
- Yellowing of skin or eyes, dark urine (may indicate liver problems)
Rare
May affect up to 1 in 1,000 people
- Severe allergic reaction (anaphylaxis) – rash, breathing difficulty, swelling of lips, face, throat
- Elevated potassium levels (hyperkalaemia) – more likely in patients with kidney problems or diabetes
- Increased eosinophil count (a type of white blood cell)
- Hair loss (alopecia)
- Osteoporosis (bone loss) with long-term use
- Tingling, numbness, and muscle weakness (especially in lower body) after spinal puncture or spinal anaesthesia
- Loss of bladder or bowel control after spinal procedures
- Hard lump or nodule at the injection site
When to Seek Medical Help Urgently
Contact your doctor immediately if you notice signs that may indicate a blood clot (which can occur paradoxically with heparin-induced thrombocytopenia):
- Deep vein thrombosis: cramping pain, redness, warmth, or swelling in one leg
- Pulmonary embolism: shortness of breath, chest pain, fainting, or coughing up blood
- Painful skin discolouration: dark red spots under the skin that do not disappear when pressed
Your doctor may request blood tests to check your platelet count if any of these symptoms occur.
How Should You Store Klexane?
Store Klexane pre-filled syringes and unopened vials at room temperature (below 25°C). Do not freeze. Keep out of the sight and reach of children. Opened multi-dose vials must be used within 28 days.
Proper storage of Klexane is essential to ensure the medication remains effective and safe to use. Follow these guidelines:
- Pre-filled syringes: Store at or below 25°C (77°F). Do not freeze. Protect from light. Do not use if the syringe is cracked, damaged, or if the solution appears cloudy, discoloured, or contains particles.
- Multi-dose vials: Store at or below 25°C (77°F). Once opened, the vial must be used within 28 days. Write the date of opening on the vial label. Do not freeze.
- General: Keep all medicines out of the sight and reach of children. Do not use after the expiry date printed on the label. The expiry date refers to the last day of that month.
- Disposal: Do not dispose of used syringes, needles, or unused medication in household waste or down the drain. Place used sharps in an appropriate sharps disposal container. Return unused medication to your pharmacist for safe disposal to protect the environment.
What Does Klexane Contain?
The active substance in Klexane is enoxaparin sodium, available in two concentrations: 100 mg/ml (10,000 IU/ml) and 150 mg/ml (15,000 IU/ml). The only other ingredient is water for injections. Multi-dose vials also contain benzyl alcohol as a preservative.
Klexane is available in a range of pre-filled syringe strengths and multi-dose vials to accommodate different dosing requirements:
| Formulation | Volume | Strength (IU / mg) | Concentration |
|---|---|---|---|
| Pre-filled syringe | 0.2 ml | 2,000 IU (20 mg) | 100 mg/ml |
| Pre-filled syringe | 0.4 ml | 4,000 IU (40 mg) | 100 mg/ml |
| Pre-filled syringe | 0.6 ml | 6,000 IU (60 mg) | 100 mg/ml |
| Pre-filled syringe | 0.8 ml | 8,000 IU (80 mg) | 100 mg/ml |
| Pre-filled syringe | 1.0 ml | 10,000 IU (100 mg) | 100 mg/ml |
| Pre-filled syringe | 0.8 ml | 12,000 IU (120 mg) | 150 mg/ml |
| Pre-filled syringe | 1.0 ml | 15,000 IU (150 mg) | 150 mg/ml |
| Multi-dose vial | 3 ml | 30,000 IU (300 mg) | 100 mg/ml + benzyl alcohol |
Klexane solution for injection is a clear, colourless to slightly yellow liquid. Do not use the product if the solution is cloudy, discoloured, or contains visible particles, or if the syringe or vial is damaged or cracked.
Sodium content: This medicine contains more than 24 mg sodium (the main component of table salt) per dose. This is equivalent to 1.2% of the recommended maximum daily sodium intake for adults.
The multi-dose vial formulation contains benzyl alcohol as a preservative. Benzyl alcohol can cause toxic and allergic reactions in infants and children up to 3 years of age. It must not be used in premature infants or neonates up to 1 month of age due to the risk of a fatal condition known as “gasping syndrome.” The benzyl alcohol-free pre-filled syringe formulation is recommended for pregnant women and neonates.
Frequently Asked Questions About Klexane
Klexane (enoxaparin) is a low molecular weight heparin used to prevent and treat blood clots. It is commonly prescribed before and after surgery to prevent deep vein thrombosis (DVT), during periods of illness-related immobility, for the treatment of existing DVT and pulmonary embolism (PE), in acute coronary syndromes (unstable angina and heart attacks), for cancer-associated thrombosis, and to prevent clotting during haemodialysis. It is given as a subcutaneous (under the skin) injection.
Klexane is injected subcutaneously into the abdomen. Choose an area at least 5 cm from the navel, alternating between left and right sides. Clean the area with an alcohol swab, pinch a fold of skin, insert the entire needle at a 90-degree angle, and push the plunger fully. Do not remove air bubbles before injecting, as this can cause medication loss. Keep the skin fold pinched during the injection. Do not rub the site afterwards to minimise bruising. Your healthcare provider must demonstrate the technique before you begin self-injecting.
The most common side effects are bleeding (which can range from injection-site bruising to serious internal haemorrhage) and elevated liver enzymes, both of which affect more than 1 in 10 patients. Common side effects (up to 1 in 10) include easy bruising, injection site reactions, skin rash, itching, anaemia, elevated platelet count, and headache. Serious but rare side effects include severe allergic reactions, heparin-induced thrombocytopenia, osteoporosis with long-term use, and spinal haematoma following spinal procedures.
Enoxaparin may be used during pregnancy under medical supervision. It does not cross the placenta in significant amounts and is considered one of the safer anticoagulant options for pregnant women. However, pregnant women with prosthetic heart valves face an increased risk of thromboembolism and require specialised monitoring. The benzyl alcohol-containing multi-dose vial formulation should be avoided during pregnancy; pre-filled syringes (which are benzyl alcohol-free) are preferred. Always consult your doctor before using any medication during pregnancy.
Klexane (enoxaparin) is an injectable anticoagulant that works within hours and has a predictable dose-response, while warfarin is an oral anticoagulant that takes several days to reach full effect and requires regular INR monitoring. Direct oral anticoagulants (DOACs) such as rivaroxaban and apixaban also work quickly and are taken orally, but unlike enoxaparin, they cannot be used in all clinical situations (e.g., mechanical heart valves, severe renal impairment). Klexane is often used as initial or bridging therapy while transitioning to oral anticoagulants.
If you miss a dose, take it as soon as you remember. Do not take a double dose to compensate. If it is almost time for your next scheduled dose, skip the missed dose and continue with your regular schedule. Setting alarms or keeping a diary can help prevent missed doses. Never stop Klexane treatment without consulting your doctor, as discontinuation can increase the risk of dangerous blood clots. If you are unsure what to do, contact your healthcare provider immediately.
References and Sources
This article is based on peer-reviewed medical literature, international clinical guidelines, and approved product information. All medical claims are supported by evidence rated at Level 1A (systematic reviews and meta-analyses of randomised controlled trials) where available.
- European Medicines Agency (EMA). Clexane (enoxaparin sodium) – Summary of Product Characteristics. Last updated 2024.
- Kearon C, Akl EA, Ornelas J, et al. “Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report.” Chest. 2016;149(2):315–352. doi:10.1016/j.chest.2015.11.026
- Konstantinides SV, Meyer G, Becattini C, et al. “2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism.” European Heart Journal. 2020;41(4):543–603.
- Collet JP, Thiele H, Barbato E, et al. “2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation.” European Heart Journal. 2021;42(14):1289–1367.
- World Health Organization. WHO Model List of Essential Medicines – 23rd List. Geneva: WHO; 2023.
- National Institute for Health and Care Excellence (NICE). Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism [NG89]. Updated 2023.
- Garcia DA, Baglin TP, Weitz JI, Samama MM. “Parenteral anticoagulants: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: ACCP Evidence-Based Clinical Practice Guidelines.” Chest. 2012;141(2 Suppl):e24S–e43S.
- Bates SM, Rajasekhar A, Engel-Nitz NM, et al. “American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy.” Blood Advances. 2018;2(22):3317–3359.
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