This MedLibrary.org supplementary page on Enoxaparin is provided directly from the open source Wikipedia as a service to our readers. Please see the note below on authorship of this content, as well as the Wikipedia usage guidelines. To search for other content from our encyclopedia supplement, please use the form below:
Related Sponsors
 |
|
|
Enoxaparin sodium
|
|
| Systematic (IUPAC) name | |
| 6-[5-acetylamino-4,6-dihydroxy-2- (sulfooxymethyl)tetrahydropyran-3-yl] oxy-3- [5-(6-carboxy-4,5-dihydroxy-3- sulfooxy-tetrahydropyran-2-yl)oxy-6-(hydroxymethyl)- 3-sulfoamino-4-sulfooxy-tetrahydropyran-2-yl] oxy-4-hydroxy-5-sulfooxy-tetrahydropyran-2- carboxylicacid | |
| Identifiers | |
| CAS number | |
| ATC code | B01 |
| PubChem | |
| DrugBank | |
| ChemSpider | |
| Chemical data | |
| Formula | (C26H40N2O36S5)n |
| Mol. mass | 4500 daltons (average) |
| Pharmacokinetic data | |
| Bioavailability | 92% |
| Protein binding | 80% bound-albumin |
| Metabolism | primarily by liver by desulfation and/or depolymerization |
| Half life | 4.5 hours |
| Excretion | ? |
| Therapeutic considerations | |
| Pregnancy cat. |
B |
| Legal status | |
| Routes | Subcutaneous (SC) Injection and intervenous (IV) per package insert |
Enoxaparin is a low molecular weight heparin manufactured by Sanofi-Aventis. It is marketed as Lovenox or Clexane. Enoxaparin injections are derived from the intestinal mucosa of pigs. Enoxaparin is used to prevent and treat deep vein thrombosis or pulmonary embolism, and is given as a subcutaneous injection (by a health care provider or the patient). Its use is evolving in acute coronary syndromes (ACS).
Contents |
Indications
In the UK, enoxaparin is approved for five indications:
- The prophylaxis of thromboembolism disorders of venous origin, in particular those which may be associated with orthopaedic surgery. There is limited evidence supporting the use of enoxaparin in orthoapedic patients1, although evidence is reasonable for colorectal patients2
- The prophylaxis of venous thromboembolism (VTE) in medical patients bedridden due to acute illness.
- The treatment of venous thromboembolism disease (VTED) presenting with deep vein thrombosis (DVT), pulmonary embolism (PE) or both.
- The treatment of unstable angina (UA) and non-Q-wave myocardial infarction (NQMI), administered concurrently with aspirin.
- The prevention of thrombus formation in the extracorporeal circulation during haemodialysis.
In the United States, enoxaparin is FDA approved for eight indications:
- Prophylaxis of DVT in medically ill patient,
- Total hip & knee replacement,
- Extended hip-replacement,
- Abdominal surgery.
- Treatment of DVT with or without PE inpatient and
- Treatment of DVT inpatient, with ACS, including STEMI.
Mechanism of action
Enoxaparin binds to and accelerates the activity of antithrombin III. By activating antithrombin III, enoxaparin preferentially potentiates the inhibition of coagulation factors Xa and IIa. The anticoagulant effect of enoxaparin can be directly correlated to its ability to inhibit factor Xa. Factor Xa catalyzes the conversion of prothrombin to thrombin, so enoxaparin’s inhibition of this process results in decreased thrombin and ultimately the prevention of fibrin clot formation.
Monitoring
- Enoxaparin does not affect the INR, PT or aPTT
- Anti-factor Xa levels can be measured, and are often used to monitor enoxaparin activity
Pregnancy
- Category B: enoxaprin is safe for use in the second trimester as it does not cross the placenta and safe while breast feeding
Side effects
- Bleeding3
- Thrombocytopenia, i.e. can be associated with heparin-induced thrombocytopenia (0.5-5.0% of patients treated for at least five days4
- Pain, bruising or irritation; hard, inflamed nodules or an itchy red rash at the injection site
- Symptoms similar to those of hayfever
- Abdominal/chest pain
- Headache
Reversal Agent
- Protamine, although not as effective at reversal as it is for heparin due to more activity at the Xa clotting factor (enoxaparin); as heparin has both Xa and IIa. Protamine sulfate will reverse enoxaparin by 66% per package insert.
Availability
100 mg/mL concentration
- Prefilled Syringes: 30mg/0.3mL, 40mg/0.4mL
- Graduated Prefilled Syringes: 60mg/0.6mL, 80mg/0.8mL, 100mg/1mL
- Multiple Dose Vials: 300mg/3.0mL
150mg/mL concentration
- Graduated Prefilled Syringes: 120mg/0.8mL, 150mg/1mL
Market
Annual sales approx $3.1bn. patent expires in 2012.
References
- ^ Warwick D, Williams MH, Bannister GC. Death and thromboembolic disease after total hip replacement. A series of 1162 cases with no routine chemical prophylaxis. J Bone Joint Surg Br. 1995 Jan;77(1):6-10. PMID 7822397
- ^ Bergqvist D. Venous thromboembolism: a review of risk and prevention in colorectal surgery patients. Dis Colon Rectum. 2006 Oct;49(10):1620-8. PMID 17019655
- ^ Warwick D, Bannister GC, Glew D, Mitchelmore A, Thornton M, Peters TJ, Brookes S. Perioperative low-molecular-weight heparin. Is it effective and safe. J Bone Joint Surg Br. 1995 Sep;77(5):715-9. PMID 7559695
- ^ Levy JH, Tanaka KA, Hursting MJ. Reducing thrombotic complications in the perioperative setting: an update on heparin-induced thrombocytopenia. Anesth Analg. 2007 Sep;105(3):570-82. PMID 17717208
External links
|
|||||||||||||||||||||||||||||||||||||||||||||
Wikipedia content modification information:
- This page was last modified on 17 December 2008, at 20:27.
Wikipedia Authorship and Review
Wikipedia content provided here is not reviewed directly by MedLibrary.org. Wikipedia content is authored by an open community of volunteers and is not produced by or in any way affiliated with MedLibrary.org.
Wikipedia Usage Guidelines
This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article on "Enoxaparin".
The URL for this specific entry is:
All Wikipedia text is available under the terms of the GNU Free Documentation License. (See Copyrights for details). Wikipedia® is a registered trademark of the Wikimedia Foundation, Inc.