Enoxaparin belongs to a group of drugs known as anticoagulants. It is sometimes referred to as low molecular weight heparin (LMWH).
Enoxaparin works in two ways:
- It prevents blood clots forming in your body.
- It stops any existing blood clots from getting bigger. Enoxaparin does NOT break down blood clots that have already formed.
Who needs to use Enoxaparin?
A person will require Enoxaparin if:
- They are at high risk of developing a blood clot. This is known as prophylaxis treatment.
- They have an existing blood clot which could potentially get bigger or dislodge and travel to other parts of the body such as the lungs. This is known as therapeutic treatment.
Some printed information suggests that enoxaparin should not be used in children. The specialists at the Queensland Children’s Hospital have been using enoxaparin to safely and effectively treat and prevent thromboembolic disorders in children for many years.
How do I obtain Enoxaparin?
Your child’s treating team will provide a prescription for enoxaparin injections which you should take to the hospital pharmacy or your local community pharmacy. Some community pharmacies may have to order enoxaparin in, so make sure you submit your prescription in advance if your child requires more injections.
How do I administer Enoxaparin?
Enoxaparin is usually administered morning and/or at night through an injection underneath the skin (known as a subcutaneous injection). However, for some babies and infants, an indwelling catheter device (Insuflon™) may be used, if appropriate. Your child’s treating team will teach you how to use enoxaparin before you are discharged.
Enoxaparin dosing is based on weight. A blood test will usually be collected two days after commencing Enoxaparin to check whether the dose is within the correct range. This blood test is called anti-factor ten A (anti-Xa) and must be collected four hours after the dose is given. Once anti-Xa levels are within the right range, testing can be done every few weeks. More frequent testing may be required in young babies and children with kidney disease/complications.
The most common side effect from enoxaparin is bleeding and bruising. This risk can be reduced by administering the correct dose and having blood testing when instructed by your treating team. Other less common effects include:
- Mild injection site reaction – ask your nurse or pharmacist for ways you might be able to reduce pain and irritation at the injection site.
- Allergic reaction – this includes shortness of breath, swelling and rashes. If this occurs at home please contact your doctor immediately. In an emergency call 000.
Some other side effects from long-term use include:
- Hair loss
- Thinning of your bones
- Haematomas – collection of blood under the skin
Contact your treating team if any of the following occurs:
- Head injury – any injury causing a knock to the head even if there is no loss of consciousness.
- Prolonged bleeding – from minor cuts, gum or nose bleeding, or periods.
- Severe headaches or back pain.
- Swelling, bruising or tender areas with no cause.
- Blood appears in any bodily fluid – urine, stools, vomit or secretions.
- You suspect the enoxaparin is causing a bad reaction in your child.
Make sure you tell your doctor, pharmacist or nurse if your child is taking other medications which may affect blood clotting including herbal/homeopathic medicines. You should also avoid medications such as aspirin, ibuprofen (nurofen) and other anti-inflammatory drugs unless specifically instructed by your doctor. If your child is taking these medications, it is important not to stop giving them unless instructed to by your doctor. Stopping blood-thinning medicines (including aspirin) without speaking to your doctor can be harmful, especially if your child has a heart condition. Ask your treating team if you are unsure.
Enoxaparin does increase your risk of bleeding so all contact sports must be avoided including football, rugby and martial arts. A helmet must be worn when undertaking activities where you are likely to fall such as bike riding or skating. Sporting activities should be discussed with your treating team and any changes in activity must be reported.
Other health professionals
When visiting other health professionals such as the dentist, physiotherapist and pharmacist etc., you must inform them that your child is on enoxaparin therapy. This will help them decide what plan of treatment is required. If your child needs to have an operation or procedure that involves the possibility of bleeding, please inform your treating team.
Queensland Children’s Hospital
Level 5, 501 Stanley Street, South Brisbane
t: 07 3068 3480
t: 07 3068 1111 (general enquiries)
In an emergency, always call 000.
NPS Medicine Wise. 2017. Clexane Forte (Solution for injection) . Accessed January 24, 2017. http://www.nps.org.au/.