I have a genetic blood disorder which requires an anticoagulant to reduce my clotting factors and prevent any existing clots from growing.
Introduction To Clexane Or Lovenox
Clexane (UK) - often known as Enoxaparin or Lovenox in the USA - is used in the treatment and prevention of blood clots or thrombosis. For those that have recently had a deep vein thrombosis or pulmonary embolism then you're likely to be in this category for your medication. For those who are unable to move, for example you're in hospital for surgery, or are suffering from a blood clot then you will likely have to take this anticoagulation as an injection too.
Clexane/Lovenox is a low-weight molecule form of heparin and is normally taken via injection once or twice a day. It is also safe to use whilst pregnant as it does not pass through the uterus or mammary glands when breast-feeding. When pregnancy happens the blood will thicken which will often put the mother and baby at risk for blood clots which is why the mother will often need to take this medication. I wrote a specific hub on Taking Clexane (Lovenox) When Pregnant if that's what you're looking for.
I have a lot of personal experience with Clexane (Lovenox) as I have to take 100mg/ml twice a day due to a very large deep vein thrombosis and also multiple pulmonary embolisms (clots in the lungs) that I got from a genetic disease called Heterozygous Factor V Leiden. It's an interesting disease which means I basically have trouble breaking down my own clots so I need to have my blood thinned and I also need a reduced platelet count while healing but that's a story for another time.
Table Of Contents
- How To Use The Injection
Instructions on how to inject.
- Video Of A Clexane Injection
An example of a Clexane injection
- The Clexane Bubble
Find out if you're supposed to inject the bubble.
- Scarring From Clexane
How to prevent scarring from the needle.
- Preventing Bruising
What you can do to reduce your bruising.
- Side Effects
Know your side effects and what to do if you experience any.
- Clexane Trivia
Some interesting facts and a quiz.
How To Use Clexane Or Lovenox
If you are in hospital then there will be a nurse that will come round and administer the correct dose either every 12 or 24 hours depending on your circumstances. However, if you are like me and have been sent home to self administer then you might be looking for a little recap on how to actually do the injection, especially if you don't have a district nurse coming in to check on you.
The injection site needs to be in a nice bit of fat as it reduces the stinging and makes the medication that much more effective. The best site is on your tummy below your navel and no closer than 2 inches as there are a load of nerves there and it can really hurt. However, if you have to take a lot of injections this site might become battered and bruised so the inner thigh and arm can also be used but these are more painful and not as effective.
The photo below the instructions shows how nasty the injection sites can get if you nick a blood vessel on the way in. If you look closely you'll also notice a lot of scarring on the injection sites, they are the white marks on my skin and you can see them standing out against the bruising. Quite often the scarring occurs because I either hit a blood vessel, just like the photo, or I got lazy in taking care of myself and didn't follow my doctor's and nurse's instructions. So, learn from my mistakes and do as you're told otherwise you'll end up with scarring like me.
This is a step-by-step set of instructions on how to get it right the first time, following these rules and you'll significantly lower your risk of bruising or scarring:
- Make sure your hands and the stomach are clean and dry.
- Find a comfortable position, I find either lying down or reclined in a chair or sofa work pretty well.
- Grasp a nice bit of fat and lift it away from the muscle.
- Put the tip of the needle on the skin and press slightly if it stings too much then find a different site as you're likely to hit a blood vessel or nerve cluster.
- Once you've found a nice place slowly push the needle into the skin - if you meet resistance take a deep breath and imagine cutting butter with a warm knife. The skin is probably a little tough but once the needle has broken through it will go in nicely.
- Slowly press the plunger down, if you go too quickly you will make the stinging a lot worse. By going slowly you allow the liquid to dissipate into the fat cells easily.
- When the plunger is all the way down slightly squeeze the fat and remove the needle. Most syringes have a safety mechanism so press the plunger until it clicks and that will retract the needle into the bottle.
- Dispose of the needle in a certified sharps box and rest up for a couple of minutes to prevent bruising.
If you need a visual demonstration on how to actually put the injection in through the skin, or how quickly you need to press in the plunger then I've actually recorded one of my injections for you to see. If you are a little squeamish or don't like to view injections then don't watch it.
Video Of A Clexane (Lovenox) Injection
Just to be clear I am not a medical professional and this information is based on my own knowledge and experiences with this specific medication and disease. If you have any specific or urgent questions please consult your doctor.
What To Do With The Clexane Bubble?
One of the questions I get from first time users about these injections is "What do I do with the bubble?" Now, a lot of injections require you to dispose of the bubble first before injecting so I can understand whey there would be a bit of confusion about it.
In the glass or plastic casing there is an air bubble which will be floating around, sometimes at the top, sometimes in the middle or at the bottom. On some syringes it is possible to flick the bubble but in most cases this is not necessary. As long as the bubble goes to the top at the plunger end when you turn the syringe up the right way then that is fine. If the bubble gets stuck then you can shake or flick the syringe depending on what type it is. By keeping the bubble at the top when you inject you maximize the amount of Clexane that remains in the body.
It is really important that you fully inject the air bubble as it allows the Clexane to remain in the body, especially if you're injecting into a really fatty area of skin. The bubble in the injection acts as a plug or stopper which is why it needs to go in last. Once all of the Clexane is in then the bubble will stay at the top of the entry site and then when the skin closes back up when the needle is removed it will seal the plug and keep the Clexane in place for the body to absorb and do it's thing.
If for some reason you have some trouble with the bubble during an injection and it just wont go in then don't panic. All you'll need to do is just remove the needle from the skin and put some light pressure on the area by placing a clean tissue and just holding it there. As long as you site quietly for a few minutes then your body will still be able to utilize the Clexane and do it's job.
If you are having problems with the bubble every single time you inject then there is something that you're not quite doing right and I would highly recommend getting some specific training or advice from your doctor or nurse who told you how to do this in the first place. On the other hand if you have troubles once in a blue moon with the injection then don't panic, it happens to the best of us as well.
Preventing And Removing Scars From Injections
As I mentioned above during the instructions for taking these injections I have got some scarring from the needles and often a lot of bruising. The best thing that you can do to prevent scarring is to follow your instructions for taking the injections and to also really look after your body too if you do get any bruising of injuries.
Now, there will be the odd time that you will nick a blood vessel or get careless and you will get the odd scar or two (or if you have to take as many as me it will be a lot more). I spoke to my doctors and nurses about what I could do to get rid of these scars and the general consensus from the medical community was that you generally can't completely get rid of the scars once they are there.
Like a lot of women I can't stand the site of scars on my skin so I wasn't going to take no for an answer and I was determined to do something to make them look better, if not removed at all. I took a look around the internet to see what the best products where for removing small scars like mine, and I also did a lot of research into which methods were best as well. After a bit of searching I found that ScarAway gel combined with the silicone sheets worked very well. You can check out my full review (see below) and what treatments are best for each type of scar. I didn't know that there were different types of scars I thought a scar was just a scar, however, once you know what types there are then you'll know exactly what you have to do to help those wounds heal.
There is far too much information to discuss in this article about the different types of scars and the best methods for healing those so I have written a specific article on it if you want to get some more information.
Scarring From Clexane (Lovenox) Injections
- Living With Factor V Leiden: What is Clexane Used For?
I talk about preventative measures and which products I prefer to use.
Tips on Preventing Bruising
If you pay attention to what you are doing then it is unlikely that you will develop a massive bruise. The photos above show how bad they can get but just bear in mind that mine get so bad because I also have a clot running alongside that area so it is super susceptible to bruising anyway.
Regardless of how good you happen to be with the needle you will get bruising from time to time. However, to prevent that you can follow these tips and also get yourself some arnica montana to apply to the area if you do get a bruise as this will help it heal twice as fast.
- Do not rub the site after the injection - this will irritate the skin and you run the risk of bursting a blood vessel.
- Do not push the air bubble out - not only will you waste valuable medication but the bubble acts as a 'plug' once the injection has been completed.
- Do not have a shower or bath immediately before or after your injections - this will dilate the blood vessels and increase the pain.
- Do not ice the area - you wont be able to tell if you're going to hit a blood vessel or nerve cluster
- Do not go through stretch marks - they hurt more
- Do remember good sites - rotate them and you'll find injecting a lot easier to cope with.
Further information can be found at this article on decreasing bruising with Clexane
Useful Products For Pain Relief
As with most treatments there will be side effects. With clexane they range from slightly irritating to fairly major, but that is a rare side effect that is treatable. So the side effects of clexane are as follows:
- Pain and irritation at the injection site - if you nick a nerve, a blood vessel or even push the fluid in too quickly it can hurt like a monkey
- Blood clots which can form a lump at the site - this normally happens if I accidentally knock the site soon after injecting and they become very tender so be careful!
- Breakdown of skin cells
- Hair loss
- Heavier periods for women - less ability to clot properly
- Decrease in the number of platelets
- Necrosis (cell death) at the site
- Blood clots in the spinal cord - only really happens if you are having a spinal or epidural anaesthesia so you'll be hospitalized anyway
- Osteoporosis - a possible side effect that can happen after long-term dosages.
Your doctors will be keeping an eye out for these symptoms and you should report them as soon as you notice something wrong. You will occasionally suffer from some mild side-effects but if you are at all worried about them then you should go straight to your doctor for a medication review.
For each question, choose the best answer. The answer key is below.
- Where is the best place to inject?
- Tummy or Thigh
- Wherever, it doesn't matter
- Should your injections be regular?
- Yes, the same time everyday is best
- No, just do it when you can
- Should you inject the bubble?
- There's a bubble?
- If you catch a blood vessel should you rub the area?
- No, it will make the bruising worse
- Yes, you'll feel better
- Depends on how much you're bleeding
- Tummy or Thigh
- Yes, the same time everyday is best
- No, it will make the bruising worse
Clexane Trivia: The NHS and Cost
For those of us in the United Kingdom we have a wonderful thing (although this is disputed) called the National Health Service (NHS). Instead of paying for the cost (or a percentage of the cost) of an item we pay a set fee for any item. Of course there are exceptions on who pays but if you're working and a taxpayer then you pay per item a fee of £7.65 (subject to change). So where does this tie into these injections?
Well, I was curious the other day to find out how much each injection actually cost seeing as I pay £7.65 per prescription. My doctor did a little a little research and it turns out that 1 of my 100mg injections cost £96! That's an extraordinary amount considering I get through 2 of these bad boys a day.
Let's just think about this for a minute. Per day I'm costing the NHS £192; per week that's £1344; per month £5376 and per year it's £64,512 on injections alone and all they want is £7.65 a month. OK NHS, if you insist that's all you want then I'll cough up just fine.
It wasn't until I got really sick that realized how lucky I am to have these systems in place, if I was anywhere else then I couldn't afford to live let alone pay for medical costs, it's hard enough as it is now!
So there we have it. For all you clexane users I hope you have found that useful. If I've left out anything or if you have some other tips then please leave a comment for me. Just remember to take your time doing the injection to minimize bruising and if you do get a bruise the stick on some arnica and you'll be right as rain in no time.
© 2012 Bobby
Tobe Advized from United Kingdom on November 13, 2016:
I just moved over from your Hub on Post-thrombotic syndrome and found this Hub you wrote about Clexane. It's most appropriate for me as I must switch from Warfarin to Clexane tomorrow for a biopsy later in the week. Although I have injected Clexane twice before, your advice is most useful. It was also interesting to see the real costs. I do hope you have recovered from your problems.
Bobby (author) from U.K on April 15, 2012:
Thanks for stopping by RNMSN.
Barbara Bethard from Tucson, Az on April 14, 2012:
very good!! informative, succinct and you covered everything!! welcome to HubPages BobSki606 :)