Comparative table of low molecular weight heparins

Licensed indication Enoxaparin (Clexane®) Inhixa (enoxaparin Crucia (enoxaparin Dalteparin Tinzaparin
biosimilar)¥ biosimilar)¥ (Fragmin) (innohep)

Prophylaxis of venous ✔ ✔ ✔ ✔ ✔
thromboembolic disease in .
moderate and high risk surgical
patients

Prophylaxis of venous ✔ ✔ ✔ ✔ ✔
thromboembolic disease in
medical patients with an acute
illness and reduced mobility at
increased risk of venous
thromboembolism

Treatment of deep vein ✔ ✔ ✔ ✔ ✔

thrombosis and pulmonary
embolism

Prevention of thrombus formation ✔ ✔ ✔ ✔ ✔

in extra corporeal circulation
during haemodialysis

Acute coronary syndrome* ✔ ✔ ✔ ✔ X

Extended treatment of X X X ✔ ✔
symptomatic venous
thromboembolism and prevention
of its recurrence in patients with
solid tumours:

Prepared by: Yuet Wan, London and South East Regional Medicines Information, Guy’s and St Thomas’ NHS Foundation Trust (30 June 2017)
 Dose in renal impairment Not recommended for As per recommendations for Clexane. In the case of
Not recommended
patients with end stage significant renal
for CrCL < 30
renal disease (CrCL <15 failure (CrCL<30
ml/min. Treatment
ml/min). Dosage table in ml/min), dose
can be used
severe renal impairment should be adjusted
cautiously when
(CrCL 15-30 ml/min) in based on anti-
CrCL down to 20
SPC. Factor Xa activity**
ml/min with anti-Xa
monitoring if
benefit outweighs
risk**
Dose in Pregnancy and None are licensed for use in pregnancy but they are used off label in practice; refer to local guidelines/expertise.
Puerperium RCOG Green top guidelines (Apr 2015) available:
Thromboembolic Disease in Pregnancy and the Puerperium: Acute Management (No. 37b):
https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-37b.pdf
Reducing the Risk of Venous Thromboembolism during Pregnancy and the Puerperium (. 37a):
https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-37a.pdf

Dose in Paediatrics None are licensed for use in paediatrics but they are used off label in practice; refer to local guidelines/expertise; paediatric dosing
guidance available in BNF-C; dilution may be required if volume too small to administer
Presentation Syringes: Syringes: Syringes: Syringes: Vials:
2,000 IU (20 mg)/0.2 ml 2,000 IU (20 mg) in 0.2 2,000 IU (20 mg) in 0.2 mL 10,000 IU/0.4ml 10,000 IU/ml
4,000 IU (40 mg)/0.4 ml mL 4,000 IU (40 mg) in 0.4 mL Ampoules: 20,000 IU/ml
6,000 IU (60 mg)/0.6 ml 4,000 IU (40 mg) in 0.4 6,000 IU (60 mg) in 0.6 mL 10,000 IU/1 ml
8,000 IU (80 mg)/0.8 ml mL 8,000 IU (80 mg) in 0.8 mL 10,000 IU/4ml Syringes:
10,000 IU (100 mg)/1 ml 6,000 IU (60 mg) in 0.6 10,000 IU (100 mg) in 1 mL Vial: 10,000 IU/ml
mL 12,000 IU (120 mg) in 0.8 mL 100,000 IU / 4ml 20,000 IU/ml
Forte Syringes: 8,000 IU (80 mg) in 0.8 15,000 IU (150 mg) in 1 mL Syringes:
12,000 IU (120 mg)/0.8 ml mL 12,500 IU/0.5ml
15,000 IU (150 mg)/1 ml 10,000 IU (100 mg) in 1 15,000 IU/0.6ml
mL 18,000 IU/0.72ml
Multidose vial 2500 IU
30,000 IU (300 mg)/3 ml 5000 IU
7,500 IU/0.3 ml
Graduated Syringe:
10,000 IU/ml
*Fondaparinux used in some trusts for acute coronary syndrome **Consult haematologist for advice on dosing in severe renal impairment ¥Licensed but not yet available in UK

Ref:

SPCs for Clexane, Fragmin, innophep via electronic Medicines Compendium, 30 June 2017, https://www.medicines.org.uk/emc/ ; EPAR: Inhixa: http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-
_Public_assessment_report/human/004264/WC500215211.pdf; SPC: Crucia: http://www.mhra.gov.uk/home/groups/spcpil/documents/spcpil/con1491541318433.pdf

Prepared by: Yuet Wan, London and South East Regional Medicines Information, Guy’s and St Thomas’ NHS Foundation Trust (30 June 2017)