Enoxaparin

( Acute coronary syndrome ; ACS )

(Low molecular weight
heparin ; LMWH ) .1916
mucosa Heparin
Heparin
1 /
, , (Hematoma)


aspirin heparin inhibit platelet aggregation coagulation UA /
NSTEMI AMI Sudden Death aspirin
anticoagulation unfractionated heparin (UFH) Low molecular -
weight heparin (LMWH) 1. Unfractionated heparin (UFH)
meta-analysis UA/ NSTEMI UFH aspirin
aspirin recurrent ischemia
MI 2-12 33 UA intermediate high risk
heparin UFH 1 60-70 / bolus
12 - 15 // aPTT 6
heparin heparin aPTT ratio

1.5-2 baseline aPTT 50-70 3-5

2. Low-molecular-weight-heparin (LMWH) LMWH

UFH anti-Xa antithrombotic
Plasma protein binding bioavailability predict anticoagulant response
monitor aPTT Heparin-induced thrombocytopenia
bioavailability rebound effect
UFH Pharmacokinetic safety profile
LMWH UFH Enoxaparin UFH LMWH
check aPTT
UFH creatinine clearance < 30 ml/min

Indirect factor Xa inhibitor : Fondaparinux

- protein binding
- antithrombin deactivate factor Xa
- case heparin thrombocytopenia
-

- Venous Thromboembolic Events (VTE)
, , ,
,
, DVT PE

- unstable angina non-ST segment elevation myocardial infarction
(UA/NSTEMI) ACS, MI refractory ischemia
- ST segment elevation myocardial infarction (STEMI)
ACS, MI
- Fondaparinux : STEMI primary PCI
Enoxaparin : Clexane
5

- UA/NSTEMI: 1mg/kg q 12 hrs ( 2-8 days )

- STEMI:
< 75 years of age >75 years of age ( Elderly )
30mg single IV bolus plus 1mg/kg SC followed by No initial IV bolus; 0.75 mg/kg SC q12
1mg/kg q12 h SC h SC

- Severe renal impairment (CrCl <30ml/mim):

< 75 years of age >75 years of age ( Elderly )
30mg single IV bolus plus 1mg/kg SC by 1mg/kg q 24 No initial IV bolus; 1 mg/kg SC q 24 h
h SC SC

- PCI : If the last CLEXANE administration was give

< 8 hours before balloon inflation No additional dosing needed
> 8 hours before balloon inflation Administer an IV bolus of 0.3 mg/kg of

CLEXANE

- Deep Vein Thrombosis

Dosage and duration
DVT treatment with or without PE 1 mg/kg BID SC for 10 days or 1.5 mg/kg OD SC for
10 days
CrCl <30ml/mim : 1mg/kg OD
DVT prophylaxis 40 mg SC, OD for 7- 10 days...4 wks, GA 12 hrs.
before surgery
LA 2 hrs after catheter removal, CrCl <30ml/mim :
20 mg OD

- Hemodialysis
Dosage and duration
Chronic hemodialysis 0.5 -1 mg/kg as a bolus in the arterial line at the
beginning of the session, half of the dosage will
6

be repeated every 2 hours if the dialysis session

last more than 4 hrs.
Hemodialysis in patients with 0.5 - 0.75 mg/kg as a bolus in the arterial line at
hemorrhagic risk the beginning of the session

- :
- : prefilled (PFS)
- : 40 mg/0.4 ml (4,000 axti Xa IU), 60 mg/0.6 ml (6,000 axti Xa IU), 80 mg/0.8
ml (8,000 axti Xa IU)

-
- /
(Hypersensitivity )
- (> 80 )
- ()
- (platelets) < 140,000 cells/cu.mm.)
(Thrombocytopenia)

- Protamine 1 . / mg enoxaparin (<= 8 )
- Protamine 0.5 mg/mg enoxaparin (> 8 <=
12)
- Protamine (> 12 )

Fondaparinux

2.5 mg 5-9 (
VTE
6-14
) 6-9

5-9

- 5 mg < 50 kg
- 7.5 mg 50-100 kg
- 10 mg >100 kg
2.5 mg .
8
STEMI IV

-
-
- (plasmapheresis)
Inj Enoxaparin : Clexane
- Enoxaparin, heparin, heparin
-
- heparin thrombocytipenias
- lab CBC, platelet count*( 50% 100,000 /mm3)
- Amikacin, Amidarone, Amphoteracin B, Atracunum,
Ciprofloxacin, Dobutamine? ( )
- Warfarin, Aspirin,
NSAIDs, Clodiprogel, Dextran, Steroids bleeding
- sign of bleeding
- MAR
- catheter 10-12

- I.M.
-
-
8

- bleeding

- Double check HN/AN

-
-
-

(Prefilled syringe) (Prefilled Syringe with
Safety Device)
0.5 . 3
- 1.

2.

HIV , Hepatitis B
(Safety lock)

1. Pre-filled syringe with safety device

CLEXANE Prefilled Syringe with Safety Device

( Needle )

(Safety device)

( Plunger )

2.
- (Subcutaneous )
5
-
3.
- :
- :
4.

-
-
( )

-
-
- (
) (

)
5.
-
-

- Plunger

: Plunger
-
****************************************************************************

10