Clotinex 100 mg/ml Injection

Low-molecular-weight heparin (anticoagulant injection) for:

• Prevention of deep vein thrombosis (DVT) after surgery or in immobile medical patients
• Treatment of DVT and pulmonary embolism
• Unstable angina and non-ST-elevation heart attack; ST-elevation heart attack (with other treatment)
• Prevention of clotting during haemodialysis
• Pregnancy-related clot prevention or treatment (specialist)

Given by subcutaneous injection (into the abdominal skin), usually by health professionals or trained patients.

• Prevention (surgery/medical): 20–40 mg once daily (40 mg for high risk), starting 12 hours before surgery or on admission, for 7–10 days or as long as risk persists.
• Treatment of DVT/PE: 1 mg/kg every 12 hours, or 1.5 mg/kg once daily, usually for at least 5 days until warfarin is effective.
• Unstable angina/NSTEMI: 1 mg/kg every 12 hours for 2–8 days, with aspirin.

Kidney impairment (CrCl < 30): prevention 20 mg once daily; treatment 1 mg/kg once daily.

• Do not expel the air bubble from pre-filled syringes before injecting; rotate sites; do not rub after injection.
• Not interchangeable unit-for-unit with other heparins.

• Active major bleeding or high bleeding risk (recent brain bleed, uncontrolled high blood pressure)
• History of heparin-induced thrombocytopenia (HIT) within 100 days or with circulating antibodies
• Allergy to enoxaparin, heparin or pork products
• Acute bacterial endocarditis
• Spinal/epidural anaesthesia within 24 hours of treatment doses

Common: bruising, pain or small lumps at the injection site, bleeding (gums, nose, urine), raised liver enzymes, anaemia.

Less common: low platelets, rash, itching.

Rare but serious: major bleeding (black stools, blood in vomit, severe headache), heparin-induced thrombocytopenia with new clots, spinal/epidural haematoma (back pain, leg numbness or weakness after spinal procedures), high potassium, osteoporosis with long-term use, skin necrosis.

• Platelet count before and during treatment (especially days 4–14).
• Elderly, low body weight, kidney impairment: increased bleeding risk — dose adjustment.
• Report unusual bleeding or bruising.
• Tell doctors and dentists before procedures.

Preferred anticoagulant in pregnancy (does not cross the placenta). Compatible with breastfeeding.

• Aspirin, NSAIDs, clopidogrel, other anticoagulants, thrombolytics, SSRIs (bleeding)
• Potassium-raising drugs: ACE inhibitors, ARBs, spironolactone (high potassium)
• Steroids (bleeding risk)

Bleeding. Protamine sulphate partially reverses it — emergency care.

Store below 25–30°C. Do not freeze. Use pre-filled syringes once only.