The therapy of thrombosis and thromboembolism is not complete without anticoagulants, which include low molecular weight heparins. These substances in the composition of medicines change blood coagulability, thereby restoring vascular patency.
Varieties of direct anticoagulants
Given the mechanism of influence of antithrombotic compounds, it can be noted that they are with direct and indirect effects. The first group of substances is most often used.
Anticoagulants of direct effect in their structure are divided into low molecular weight and unfractionated heparins. They can also be direct thrombin inhibitors, such as, for example, hirudin.
Characterization of low molecular weight heparins
They are also called fractionated compounds, in which the molecular average mass ranges from 4000 to 6000 daltons. Their activity is associated with indirect inhibition of the formation and activity of a thrombin enzyme. Heparin exerts this effect on blood coagulation factor Xa. The result is anticoagulation and antithrombotic action.
Low molecular weight heparins are obtained from unfractionated substances isolated from the intestinal epithelium of a pig during a chemical or enzymatic depolymerization process. As a result of such a reaction, the polysaccharide chain is shortened by one third of the original length, which contributes to a decrease in the anticoagulant molecule.
There are various low molecular weight heparins, the classification of which is based on methods for producing salt-containing compounds.
Release Forms
Preparations based on them are injection solutions for the administration of subcutaneous or intravenous. They are usually packaged in ampoules or syringes for single use.
Low molecular weight heparins in tablets are not produced.
Do not use drugs intramuscularly.
Description of the drug "Gemapaksan"
Refers to anticoagulant drugs with direct action. The active ingredient is enoxaparin in the form of a sodium salt, which is considered to be a derivative of heparin. This modification provides high adsorption when administered subcutaneously and low individual sensitivity.
It is produced by the Italian company Italfarmaco S.p.A. in the form of a clear, colorless or light yellow injection solution, packaged in syringes of 0.2, 0.4 or 0.6 ml.
Dosages of enoxaparin sodium are 2000 IU in 20 mg; 4000 IU in 40 mg and 6000 IU in 60 mg. The active ingredient of the drug is dissolved in injectable water.
Enoxaparin sodium exhibits a high inhibitory effect on factor coagulation Xa and a low effect on antithrombin at a dose of 100 IU per 1 mg at a dose of 28 IU per 1 mg.
The use of a therapeutic concentration of the drug for various diseases does not lead to an increase in the duration of blood loss.
The prophylactic sodium enoxaparin dosage does not alter the partially activated thromboplastin time, does not interfere with platelet adhesion and the process of combining them with fibrinogen molecules.
Low molecular weight heparins in a higher concentration of the drug (6000 IU in 0.6 ml) are used:
- for the treatment of thrombosis in deep veins;
- with angina pectoris of an unstable and infarcted state of the myocardial muscle in combination with acetylsalicylic acid;
- for the prevention of increased coagulation during the hemodialysis procedure.
The introduction of a subcutaneous solution with a dosage of 2000 and 4000 IU per 0.2 and 0.4 ml, respectively, is used to prevent thrombosis and thromboembolic state of the venous system:
- during surgical operations of orthopedic nature;
- to bed patients with insufficiency of a chronic respiratory apparatus or cardiac system of type 3 and 4;
- in acute infectious or rheumatic diseases, when there is a risk factor for the formation of blood clots;
- elderly patients;
- with excessive deposition of fat;
- with hormone therapy.
The drug is used subcutaneously in the abdominal wall, in its posterior and anterolateral zone.
The medication is contraindicated in thrombocytopenia, bleeding, coagulation disorders, peptic ulcer of the stomach and duodenal ulcer, subacute bacterial endocarditis, diabetes mellitus, hypersensitivity and pregnancy.
Hemapaxan medicine: price
The cost of an injection solution containing 2000 IU per 0.2 ml in a syringe for six pieces is 955 rubles.
For larger dosage the drug "Hemapaxan" the price ranges from 1,500 rubles per pack with six syringes.
Description of the drug "Clexane"
Refers to similar drugs based on enoxaparin sodium. It is produced by the French company Sanofi Aventis in the form of an injectable clear solution, which can be colorless or with a faint yellow tint.
There are dosages of the drug "Clexane" at 10,000, 8,000, 6,000, 4,000 and 2,000 IU of enoxaparin sodium at 1.0; 0.8; 0.6; 0.4; 0.2 ml of drug fluid, respectively. The content of the active ingredient in 1 mg of the solution is 1000 IU.
Low molecular weight heparins are available in glass syringes, which in a pack can be 2 or 10 pieces.
The medicine "Kleksan" conducts the prevention of thrombotic and thromboembolic disorders in the veins during surgical intervention associated with orthopedics, and with hemodialysis.
The solution is injected subcutaneously to eliminate the thrombotic state in the deep veins and in the arteries of the lung.
The drug treats angina pectoris of an unstable nature and myocardial infarction in combination with Aspirin tablets.
The medicine "Clexane": price
The cost of an injection solution containing 2000 IU per 0.2 ml for one syringe is 175 rubles.
For one unit with a dosage of 4000 IU per 0.4 ml, you will have to pay 280 rubles, for 6000 IU per 0.6 ml - 440 rubles, for 8000 IU per 0.8 ml - 495 rubles.
For the Clexan preparation, the price for a package of 10 pieces with a dose of 20 mg, 40 mg and 80 mg is 1685, 2750, 4000 rubles.
Description of the drug "Fragmin"
The active component of this medication is a heparin derivative, a substance represented by sodium dalteparin. It is obtained by depolymerization under the action of nitrous acid , followed by purification using ion exchange chromatography. Sodium dalteparine salt includes sulfated polysaccharide chains with an average molecular weight of five thousand daltons.
Auxiliary components are injection water and sodium chloride salt. The Belgian drug “Fragmin” describes the instruction as a solution for injection subcutaneous and intravenous administration in the form of a clear liquid, without color or with a yellowish tinge.
It is released in single-dose glass syringes of 2500 IU in 0.2 ml; 5000 IU in 0.2 ml; 7500 IU in 0.3 ml; 10,000 IU in 1.0 ml; 12500 IU in 0.5 ml; 15000 IU in 0.6 ml; 18000 IU in 0.72 ml.
The drug “Fragmin”, the instruction recommends that it be used for prophylactic purposes to control the mechanism of blood coagulation during hemodialysis and hemofiltration measures aimed at treating renal failure, to prevent clot formation in surgery.
The medication is administered to eliminate thromboembolic lesions of bedridden patients.
The solution treats angina unstable and myocardial infarction, symptomatic venous thromboembolism.
Description of the medicine "Anfibra"
He is ranked among the low molecular weight heparins of the Russian company Veropharm OJSC. Exists in the form of a solution transparent for injection, which can be colorless or with a yellowish tint.
The product is based on the sodium salt of enoxaparin, which may contain 2000 IU in 0.2 ml; 4000 IU in 0.4 ml; 6000 IU in 0.6 ml; 8000 IU in 0.8 ml; 10,000 IU in 1.0 ml. As a solvent, distilled water is used.
Packed in ampoules or syringes of 1 ml, which are 2, 5 and 10 pieces are packed in packs of cardboard.
The drug "Anfibra" instruction recommends use to prevent the development of a thromboembolic state during surgical procedures and hemodialysis, in the treatment of the formation of clots in deep-seated vessels.
The solution treats an unstable nature of angina pectoris and a heart attack state of the heart muscle, in which there is no Q wave on the electrocardiogram.
Description of means "Fraksiparin"
Calcium nadroparin, which is obtained during the depolymerization process, belongs to low molecular weight heparins . Its molecules are glycosaminoglycans, the average molecular weight of which is 4300 daltons.
The drug “Fraxiparin” (subcutaneous injections) in its composition contains hydroxide and calcium nadroparin salt, which are dissolved in injection water.
The dosage of the active ingredient is 2850 ME in 0.3 ml; 3800 ME in 0.4 ml; 5700 ME in 0.6 ml, 7600 ME in 0.8 ml, 9500 ME in 1 ml.
The drug is a transparent or slightly opalescent liquid that has a light yellow tint or is completely colorless.
The nadroparin salt binds well to antithrombin protein III, which causes accelerated inhibition of factor Xa. The substance activates an inhibitor that provides the conversion of tissue factor, reduces blood viscosity and increases the membrane permeability of platelet and granulocyte cells. So the antithrombotic effect of the drug is carried out.
Fraksiparin injections are prescribed to prevent a thromboembolic state during orthopedic surgery and hemodialysis. The medicine is administered to patients with a high risk of blood clots, acute respiratory and heart failure, unstable angina, myocardial muscle infarction with no Q-wave.
The use of anticoagulants in bearing a child
During pregnancy, low molecular weight heparins are prescribed to patients with bleeding disorders so that a placental thrombus does not form, which leads to abortion, to a pre-eclampsic state with high blood pressure, to the detachment of a child’s place with severe bleeding, to a slowed growth of the fetus in the uterus, which will cause low baby weight.
Such anticoagulants are prescribed to women in a position with a possible risk of clot formation in deep veins, for example, on the lower extremities, as well as obstruction of the lung artery.
Therapy with low molecular weight heparins is a painful process in which a pregnant patient daily injects the drug under the skin on her stomach.
However, in clinical randomized trials, results were obtained that prove that often the use of such anticoagulants does not contribute to a positive effect. It was also found that therapy with low molecular weight heparins can harm the mother's body, associated with increased bleeding and a decrease in pain relief of labor.
These studies have shown that canceling anticoagulant treatment can save many women from unnecessary pain symptoms while carrying the baby.
In the instructions for the use of drugs based on heparin, low molecular weight therapy during pregnancy is contraindicated.