SHORTAGE OF CLEXANE INJECTION: ALTERNATIVE THERAPEUTIC OPTIONS Comparative table of low molecular weight heparins Licensed indication Enoxaparin (Clexane®) Inhixa (enoxaparin Arovi (enoxaparin Dalteparin Tinzaparin Fondaparinux biosimilar)Ω biosimilar)¥ (Fragmin®) (Innohep®) (Arixtra) Prophylaxis of venous ✔ ✔ ✔ ✔ ✔ ✔ thromboembolic disease in . moderate and high risk surgical patients Dose in moderate and high risk Moderate risk (MR): 2000 IU/day; high risk (HR) 4000 IU/day MR: 2500 IU/day; MR: 3500 IU/day; 2.5 mg/ day surgical patients HR 5000 IU/day HR 4500 IU/day Prophylaxis of venous ✔ ✔ ✔ ✔ ✔ ✔ thromboembolic disease in medical patients with an acute illness and reduced mobility at increased risk of venous thromboembolism (weight based dosing for LMWHs) Treatment of deep vein ✔ ✔ ✔ ✔ ✔ ✔ thrombosis and pulmonary embolism (weight based dosing for LMWHs) Prevention of thrombus formation X ✔ ✔ ✔ ✔ ✔ in extra corporeal circulation during haemodialysis Acute coronary syndrome* X ✔ ✔ ✔ ✔ ✔ (weight based dosing for LMWHs) Extended treatment of X X X X ✔ ✔ symptomatic venous thromboembolism and prevention of its recurrence in patients with solid tumours (weight based dosing) Dose in renal impairment Not recommended for As per recommendations for enoxaparin. In the case of Not recommended Contra-indicated in patients with end stage significant renal for CrCL < 30 severe renal renal disease (CrCL <15 failure (CrCL<30 ml/min. Treatment impairment (CrCL ml/min). Dosage table for ml/min), dose can be used <30 ml/min) and severe renal impairment should be adjusted cautiously when used with caution CrCL down to 20 in moderate renal
SHORTAGE OF CLEXANE INJECTION: ALTERNATIVE THERAPEUTIC OPTIONS Comparative table of low molecular weight heparins Licensed indication Enoxaparin (Clexane®) Inhixa (enoxaparin biosimilar)Ω Arovi (enoxaparin biosimilar)¥ Dalteparin (Fragmin®) Tinzaparin (Innohep®) Fondaparinux (Arixtra) Prophylaxis of venous thromboembolic disease in moderate and high risk surgical patients ✔ ✔ ✔ ✔ . ✔ ✔ Dose in moderate and high risk surgical patients Moderate risk (MR): 2000 IU/day; high risk (HR) 4000 IU/day MR: 2500 IU/day; HR 5000 IU/day MR: 3500 IU/day; HR 4500 IU/day 2.5 mg/ day Prophylaxis of venous thromboembolic disease in medical patients with an acute illness and reduced mobility at increased risk of venous thromboembolism (weight based dosing for LMWHs) ✔ ✔ ✔ ✔ ✔ ✔ Treatment of deep vein thrombosis and pulmonary embolism (weight based dosing for LMWHs) ✔ ✔ ✔ ✔ ✔ ✔ Prevention of thrombus formation in extra corporeal circulation during haemodialysis ✔ ✔ ✔ ✔ ✔ X Acute coronary syndrome* (weight based dosing for LMWHs) ✔ ✔ ✔ ✔ X ✔ Extended treatment of symptomatic venous thromboembolism and prevention of its recurrence in patients with solid tumours (weight based dosing) X X X ✔ ✔ X Dose in renal impairment Not recommended for patients with end stage renal disease (CrCL <15 ml/min). Dosage table for severe renal impairment As per recommendations for enoxaparin. In the case of significant renal failure (CrCL<30 ml/min), dose should be adjusted Not recommended for CrCL < 30 ml/min. Treatment can be used cautiously when CrCL down to 20 Contra-indicated in severe renal impairment (CrCL <30 ml/min) and used with caution in moderate renal
Comparative-table-LMWH-and-DOAC-summary-16-Oct-2018.docx