All you need to know about Clexane

You may have recently attended a pre-op appointment for surgery where you have been told by your doctor that you are to be given a series of Clexane injections, as I was after my hysterectomy. But what are they for? Hopefully this post will answer all your questions and give you tips for making the actual injections themselves easier.

What do Clexane injections do?

They are an anticoagulant and help to reduce the risk of blood clots. Therefore, they are a blood thinning injection. In most cases, Clexane injections are used as a preventative measure but in some cases, they are used as treatment of deep vein thrombosis.

Clexane and other anticoagulant injections are a subcutaneous injection meaning they are administered into the fatty bit just under the skin.

Why is developing a blood clot so dangerous?

Blood clots can develop in the body’s large veins (typically in the legs). This is a condition known as Deep Vein Thrombosis (Shortened to DVT). The danger occurs if these blood clots start to break free of their original spot and start to travel through the bloodstream. They can aim for the lungs and chest, causing difficulty in breathing, heart attack and even death. So, in short, although these injections can be slightly unpleasant in the short term, they are definitely worth having! 

What other names are there for Blood Thinning Injections?

Some people refer to them as anticoagulant injections – meaning it will treat and stop blood clots forming in the blood vessels and in the heart. The actual generic name for Clexane is Enoxaparin. Clexane is the brand name for this type of treatment, along with other brand names that you may find:

• Lovenox
• Klexane 
• Qualiop 
• Enoxaparin Sanofi

These are the most common types of anticoagulant injections used across Europe.

Who needs blood thinning injections?

Most people will now be offered Clexane or another form of blood thinning injections after surgery but there are other cases in which these injections may be necessary. This is a prescription drug that can only be issued by a registered health professionals.

Clexane (Enoxaparin) is also given to people with unstable angina to treat sudden angina attacks and also to prevent chest pain from angina attacks when doing activities that typically bring on the symptoms – brisk walking and playing sports.

Who is most at risk of developing blood clots/DVT?

• People over the age of 40.
• People who take the combined oral contraceptive pill.
• People who are taking HRT (Hormone Replacement Therapy).
• People with heart problems and heart associated medical conditions.
• People who are obese – Typically this is people with a BMI over 30. Your healthcare provider will be able to advise you on this.
• If you have previously had a DVT – to prevent new blood clots.
• If you have recently had surgery (Both minor and major surgery)- in particular knee replacements, abdominal surgery and hip replacements. I have known very young people (around 18-20) who have also had surgery not in these areas, who have been prescribed Clexane injections so it is definitely becoming more common for people in all age groups. I also know of a lady in her early thirties who has broken her ankle and will be taking Clexane for the foreseeable while she heals.
• People who suffer from varicose veins.
• People who are undertaking a long journey where they will not be able to move around much.
• People having cancer treatment.
• People who are required to have long periods of bed rest.
• Pregnant women.

How long will I need these injections for?

The typical timescale for having Clexane injections is around 7-10 days. I was given one week’s dose when I had my 3rd daughter but after my hysterectomy, I had to have them for a complete month.

Some doctors say to keep having the injections until the end of the course OR until you are moving around a lot more. I went back to my hospital after 4 weeks and was told I could leave the last 4 injections as I was moving around enough. (Hurrah for laparoscopic rather than abdominal hysterectomies!)

Can I administer my Clexane injection myself?

Yes, you can and many people do. Some professionals say that injecting yourself will allow you more control over the area and may reduce the pain of the injection site.

For a lot of people, (myself included) the mere thought of injecting yourself gives them the shivers. In this instance, you might be better getting your partner to do the injection for you. In rare cases, you might be really lucky, like me, and find a husband who relishes the thought of injecting his wife! 

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How do I know what dose to give?

You will be given a set amount of prefilled syringes so you don’t have to worry about how much Clexane to administer.

Tips for giving Clexane injections

• Wash your hands with soap and water. Dry thoroughly, you don’t want slippy hands just as you are injecting.
• Check the syringe to make sure it is within the expiry date.
• Sit or lie in an comfortable position. If you are injecting yourself you obviously need to see where you will be inserting the needle so maybe best to sit up.
• Make sure your Sharps box is within easy reach. (Although most syringes now have a cover that goes over the needle as soon as the Clexane has been injected so you are not likely to be walking around the house with an exposed needle).
• Pinch an inch – God knows how people with washboard stomachs manage. Its unlikely I will ever come across this problem but feel free to share if you know what to do.
• Rotate through locations. *Always below the waist* – bum x 2, belly x 2, thighs x 2 and, if you’ve got the fat to, high hips x 2.
• Try not to inject into a bruise that is already there (If you have had abdominal surgery you will have some bruising coming out already and you may have bruises from the previous few days’ injections.
• Gently press the eye on the skin, if it hurts move it.
• Hold the syringe like a pencil in the hand you usually write with. Make sure not to bend the needle as you are removing the cap.
• When you’re happy with your spot gently push the needle in.
• Make sure the air bubble is under the plunger (it’s supposed to be there, it makes sure you get all the dose) and the eye of the needle faces upwards.
• Do not move the needle when it is injected into your skin.
• Do not let go of the skin that you are pinching until you have removed the needle.
• Remove and press the plunger one last time to put the needle cap over the needle.

Where do I inject?

Into the stomach area – underneath the belly button and to the side. We did try more over to the hip one day. Ouch! Won’t be trying that again! Some people say that they like to inject further down towards the bikini line area – Nope, that wasn’t happening either.

Other people say that they really didn’t get on with injecting into the stomach area and chose instead, to inject into their thigh and then sometimes into their bum cheek (I’ve certainly got no shortage of padding there!). I’ve had a previous injection into the muscle of my thigh and hated it, so not for me. Speak to your nurse or doctor if you think this may be for you.

Is there any way of stopping the bruising?

Nurse friends have said not to rub the injection site straight after the injection as you are encouraging the affected areas to bruise.

How can I stop my Clexane injection from hurting?

There are 2 ways that having a Clexane injection can be painful.

• The actual injection being inserted itself. Once you go home from the hospital or doctor, you tend to be on your own and at the mercy of a non-professional administering your injection. Asside from following the Tips on giving Clexane injections above, some people find that holding an ice cube or ice-pop against your skin for around a minute before having the injection, makes the area numb so you don’t feel it as much. One bonus is you can reward yourself by eating the ice-pop when the injection is done!
• A minute or so after having your injection, you will probably find that you will have some stinging (some lucky people don’t!)

I have a phobia of needles – Is there anything I can do instead?

I have spoken to one lady who said she was on long term blood thinning injections due to breaking her leg. She had really struggled with the injections and had been provided with blood thinners in tablet form instead. She was so much happier. If you are really finding the injections difficult, this may be worth exploring with your doctor, as an option for you?

(See side effects for possible complication from oral anticoagulants).
 

What time of day should I have my blood thinning injection?

I was never told this at the hospital but apparently, the best time to have your Clexane injection is in the evening. I suppose this does make sense when you think about it, as you are just about to have a prolonger period of inactivity when you are in bed asleep.

How do I dispose of the needle after injecting?

You will be provided with a sharps box by your healthcare provider along with instructions where to take it once you have finished the course of anticoagulant medicine. Most pre-filled syringe cases also come with an attached cover that goes over the needle straight after the injection has been administered. Make sure this has covered the needle before inserting into the sharps box.

Most chemists will allow you to drop your sealed box into them afterwards but you might need to go with the pharmacy that works in association with your local GP.

Does Clexane have any side effects?

These are the most common side effects associated with anticoagulant medication. Most side effects of Clexane are minor, but if you think you are suffering from any others or having an extreme reaction, seek professional medical advice straightaway. Severe allergic reaction is very rare – Most people do not experience side effects other than at the side of injection, which tends to be shortlived.

• Bruising around the injection site area is really quite common along with stinging a short while after the injection being administered. 
• I tried saving something interesting to do straight after having the injection to distract me from the inevitable sting. It only last a couple of minutes typically but things like opening the post, watching a favourite programme, eating something good didn’t half help.
• If you have any unusual swelling, redness or oozing where you have been administering your previous injections, speak to your nurse or doctor before continuing with your programme.
• Be careful when shaving or using knives as the risk of bleeding heavily increases if you cut yourself.
• There is a possible rare side effect of the oral form of enoxaparin with the potential to cause kidney problems. These possible side effects are called anticoagulant-related nephropathy (ARN) and results from bleeding in the kidneys. Although this side effect is rare, it is serious and can be life-threatening.

It seems to be hurting more the longer I have these Clexane injections, is this right?

Reports do suggest that people start feeling the pain more towards the end of your Clexane journey. There are various theories around this:

• The length of time since you had surgery has passed and you might not be as distracted by any surgical pain.
• Your skin will be more tender from having previous injections around that area.
• You are likely to be completely cheesed off with having these injections and just want them over. Promise yourself a treat at the end of it and you will feel better!

Where to store Clexane injections before using?

Clexane should be stored at room temperature – not in the fridge or the freezer.

It should be kept in a safe place, out of reach of children.

Who cannot have Clexane?

People who are hypersensitive/allergic to enoxaparin or heparin.

Speak to your doctor or nurse if you are prescribed regular aspirin.

How to tell if you have a DVT

I couldn’t write a post about preventing DVTs without addressing what to look for if you think you may have one. There are 3 main symptoms to look for:

• Pain or tenderness in the calf or thigh.
• Swelling, redness or skin colour change.
• Warmth in your calf or leg.

What do I do if I miss a dose of Clexane or Anticoagulant injection?

If you are within a few hours of your usual dose, then take as soon as possible. 

If you have just one missed dose, then continue to take your next dose as usual for the remainder of your prescription.

If you have missed several doses, speak to your healthcare provider as soon as possible.

Can i buy my own Clexane?

No, this is a prescription only type of medicine. Suppliers require identification to prevent members of the general public from trying to buy Clexane.

Helen is a family and lifestyle blogger, writing about her experiences of bringing up 3 girls. For more information about the Costello Family and the services they can offer visit the Work With Us page

Photographs c/o Unsplash: 1. Nathan Dumlao 2. Fabian Moller 3. Enric Moreu