Heparins of low molecular weight: preparations, indications for use

Therapy of thrombosis and thromboembolism does not do without anticoagulants, which include heparins of low molecular weight. These substances in the composition of medicines change the coagulability of the blood, thereby restoring the patency of the vessels.

Types of direct anticoagulants

Given the mechanism of influence of antithrombotic compounds, it can be noted that they are with direct and indirect action. The first group of substances is most often used.

Anticoagulants of direct influence in their structure are divided into heparins of low molecular weight and unfractionated. They can also be direct inhibitors of thrombin, such as, for example, hirudin.

Characteristics of heparins of low molecular weight

They are termed differently fractional compounds, in which the molecular mean mass varies from 4000 to 6000 daltons. Their activity is associated with indirect inhibition of the formation and activity of the thrombin enzyme. This effect has a heparin on the blood coagulation factor Xa. The result is an anticoagulant and antithrombotic effect.

Low molecular weight heparins are obtained from unfractionated substances isolated from pig intestinal epithelium during a chemical or enzymatic depolymerization process. As a result of this reaction, the polysaccharide chain is shortened by one-third of the original length, which helps to reduce the anticoagulant molecule.

There are different low molecular weight heparins, the classification of which is based on the methods of obtaining salt-containing compounds.

Forms of release

Preparations on their basis are injectable solutions for the administration of subcutaneous or intravenous. Usually, they are packed into single-use ampoules or syringes.

Heparins of low molecular weight are not produced in tablets.

Intramuscular medication is not used.

Description of the drug "Hemapaksan"

Refers to anticoagulant drugs with direct action. The active ingredient is enoxaparin in the form of a sodium salt, which is considered a derivative of heparin. This modification provides high adsorption when administered subcutaneously and low individual sensitivity.

Produced by the Italian company "Italpharmaco SpA" in the form of a transparent, colorless or light-yellow solution for injection, put into syringes of 0.2, 0.4 or 0.6 ml.

Dosages of sodium enoxaparin 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 the injectable water.
Sodium enoxaparin exhibits a high inhibitory effect on the blood coagulation factor Xa at a dosage of 100 IU per mg and a low effect on antithrombin at a dose of 28 IU per mg.

The use of therapeutic drug concentration 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 disrupt platelet clumping, and the process combines them with fibrinogen molecules.

Heparins low molecular weight in a greater concentration of the drug (6000 IU in 0.6 ml) are used:

• For the therapy of thrombosis in the veins of deep;
• With angina pectoris forms unstable and infarcted state of myocardial muscle in combination with acid acetylsalicylic;
• For the prevention of increased coagulation for the period of hemodialysis procedure.

Introduction subcutaneous solution with a dosage of 2000 and 4000 IU of 0.2 and 0.4 ml, respectively, is used to prevent thrombosis and thromboembolic state of the venous system:

• When carrying out operations of surgical orthopedic nature;
• To bed patients with insufficiency of the chronic respiratory apparatus or heart system of 3 and 4 types;
• In acute infectious or rheumatic diseases, when there is a risk factor for the formation of blood clots;
• Elderly patients;
• With excess fat deposition;
• When hormone therapy.

The drug is used subcutaneously in the abdominal wall, in its posterior and anterolateral zone.

The drug is contraindicated in patients with thrombocytopenia, bleeding, clotting disorders, peptic ulcer disease of the stomach and duodenum, subacute bacterial endocarditis, diabetes mellitus, hypersensitivity and pregnancy.

Medication "Hemapaksan": price

The cost of the injection solution containing 2,000 IU per 0.2 ml in a syringe for six pieces is 955 rubles.

For a greater dosage Of the drug "Hemapaksan" the price fluctuates within 1500 rubles per package with six syringes.

Description of the drug "Kleksan"

Refers to similar products based on sodium enoxaparin. Produced by the French company Sanofi Aventis in the form of an injectable clear solution, which can be without color or with a slightly yellowish tinge.

There are dosages of the drug "Kleksan" for 10000, 8000, 6000, 4000 and 2000 IU of sodium enoxaparin in 1.0; 0.8; 0.6; 0.4; 0.2 ml of the drug liquid, respectively. The content of the active ingredient in 1 mg of the solution is 1000 IU.

Heparins of low molecular weight are produced in glass syringes, which in a bundle can be 2 or 10 pieces.

The drug "Clexan" is used to prevent thrombotic and thromboembolic disorders in the veins during surgery, associated with orthopedics, and hemodialysis.

The solution is administered by the subcutaneous route when the thrombotic state in the veins of deep and in the arteries of the lung is eliminated.

The drug treats unstable angina and myocardial infarction in combination with "Aspirin" tablets.

Medication "Clexane": price

The cost of the injection solution containing 2000 IU per 0.2 ml per syringe is 175 rubles.

For one unit with a dosage of 4000 IU per 0.4 ml, 280 rubles will be paid, for 6000 IU for 0.6 ml - 440 rubles, for 8000 IU for 0.8 ml - 495 rubles.

On the drug "Clexane" 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 ingredient of this medication is a substance derived from heparin, a substance represented by sodium dalteparin. It is obtained by depolymerization under the influence of nitrous acid with subsequent purification, using ion-exchange chromatography. Sodium dalteparin salt includes chains of polysaccharide, subjected to sulfation, with an average molecular weight of five thousand daltons.

Auxiliary components are water injection and sodium chloride salt. Belgian drug "Fragmin" instruction describes as a solution for injections of subcutaneous and intravenous administration in the form of a liquid that is transparent, colorless or with a yellowish tinge.

It is produced 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; 15,000 IU in 0.6 ml; 18,000 IU in 0.72 ml.

The drug "Fragmin" instruction recommends the use in preventive purposes to control the mechanism of blood coagulation in hemodialysis and hemofiltration measures aimed at treating kidney failure, to prevent the formation of clots in surgery.

The medication is administered to eliminate thromboembolic injury of recumbent patients.

The solution is treated with stenocardia unstable and myocardial infarction, symptomatic venous thromboembolism.

Description of the medicine "Anfiber"

He is considered to be a low-molecular weight heparin of the Russian enterprise of OJSC Veropharm. There is in the form of a solution that is transparent for injection, which can be without color or with a yellowish tinge.

The product is based on the sodium salt of enoxaparin, which can 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. The solvent used is distilled water.

Packed in ampoules or syringes of 1 ml, which are 2, 5 and 10 pieces packed in packs of cardboard.

The drug "Anfibra" instruction recommends the use to prevent the development of thromboembolic state during surgical manipulation and hemodialysis, in the treatment of clot formation in deep-lying vessels.

The solution is treated with unstable angina and heart condition of the heart muscle, in which there is no Q tooth on the electrocardiogram.

Description of "Fraksiparin"

To heparins, low-molecular weight is the calcium of the supra -parrin, which is obtained during the depolymerization process. Its molecules are glycosaminoglycans, the average molecular weight of which is 4,300 daltons.

The drug "Fraksiparin" (injections subcutaneous) in its composition contains hydroxide and calcium supraparrin salt, which are dissolved in injectable water.

The dosage of the active ingredient is 2850 IU 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 clear or slightly opalescent liquid that has a light yellow hue or is completely colorless.

Nadroparinic salt binds well to the antithrombin protein III, which causes an accelerated inhibition of Xa factor. The substance activates an inhibitor that transforms the tissue factor, lowers blood viscosity and increases the membrane permeability of platelet and granulocyte cells. This is the antithrombotic effect of the drug.

"Fraksiparin" injections are prescribed to prevent a thromboembolic state during surgical manipulations of the orthopedic nature and hemodialysis. The medication is administered to patients who have a high risk of blood clots, acute failure of the respiratory and heart organs, unstable angina, myocardial muscle, a non-Q-wave infarction.

Use of anticoagulants in bearing a child

Low molecular weight heparins in pregnancy are prescribed to patients with bleeding disorders, so that a placental thrombus does not form, which leads to abortion, a pre-eclampsia state with high blood pressure, a detached child's place with heavy bleeding, slow growth of the embryo in the uterus, which will cause a low Weight of baby.

Such anticoagulants are prescribed to women in the position with a possible risk of clots formation in deep veins, for example, on the lower limbs, as well as obstruction of the artery of the lung.

Therapy with low molecular weight heparins is a painful process, in which the pregnant patient daily injects the drug under the skin on the abdomen.

However, in clinical randomized trials, results have been obtained that prove that often the use of such anticoagulants does not contribute to a positive effect. Also found that therapy with low molecular weight heparins can harm the maternal organism associated with increased bleeding and reduced analgesia of labor.

These studies have shown that the abolition of anticoagulant treatment can save many women from unnecessary pain symptoms during the baby's bearing.

In the instructions for the use of drugs based on heparin low-molecular therapy during pregnancy is contraindicated.