Anticoagulant (blood thinning) treatment with enoxaparin injection

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What is this information about?

This information is about enoxaparin. Enoxaparin is one type of a group of medications called anticoagulants. It is used to help prevent blood clots by slowing down clot formation. A blood clot is a blockage in a blood vessel that stops blood from flowing properly.  A blood clot can cause serious illness if it is not treated.

Blood does not usually clot (coagulate) in blood vessels, but this can happen after an illness or operation or after a time when you are not able to walk or move around (when you are immobile).

You can find more information about blood clots in our leaflet ‘Reducing the risk of blood clots with lower limb immobilisation’. Please ask for a copy if you have not been given it already.

This information will tell you:

• about the dose of enoxaparin that you need
• what you need to check before you use your pre-filled syringes
• how to use pre-filled syringes to inject enoxaparin
• how you should dispose of used syringes
• possible side-effects of enoxaparin and what to do if you have them
• the answers to other FAQs.

Why have I been given this information?

You have been given this information because you need to take enoxaparin. This is because there is a higher than usual chance that you may get a blood clot. The advice in this information, if you follow it, will help you to inject your enoxaparin safely and reduce the chance that you will get a blood clot.

How will I know how much enoxaparin I need to inject?

We work out the amount of enoxaparin you need (your dose) depending on your weight. We will give you syringes which already have the right dose of enoxaparin for you in them (prefilled syringes).

Do: make sure that you inject all of the liquid in the syringe

Do not: change the dose you inject unless you are told to do so by your doctor or pharmacist

Must I check each syringe before I use it?

Yes.

• Check to make sure that the liquid in the syringe:
  • is not discoloured
  • does not have particles in it.

Do not use the syringe if it is discoloured or has particles in it.

• Check to make sure the syringe has no leaks

How should I inject enoxaparin?

Enoxaparin is given by a small injection under the skin. You should inject (or give) the dose of enoxaparin at the time recommended by your doctor.

Get ready for the injection by:

• getting the single dose enoxaparin syringe and the yellow sharps bin near you and ready to use
• washing and drying your hands
• cleaning (wiping) the area of skin that you will be injecting into
• if a carer is giving you the injection, they should wear disposable latex or vinyl medical gloves.

Follow the steps below to give the injection:

Step 1: Get into a comfortable sitting position where you can see your stomach or thighs.

Step 2: Choose an injection site either on your stomach or outer thighs (see shaded areas in the image). The site must be 5cm away from your belly button, or any scars, wounds, or redness.

It is important that you chose a different site each time.

Step 3: Remove the grey rubber needle cap by pulling it straight off. You will notice an air bubble in the syringe. It is supposed to be there, and you can just ignore it. Do not press the plunger yet.

Step 4: Hold the syringe in one hand and with the other hand, gently pinch a fold of skin with its fatty tissue. This will be the injection site.

Step 5: Hold the syringe above the folded skin keeping it at a right angle (as in the diagram). Insert the needle into the skin until it is fully inserted.

Step 6: Now press the plunger and inject the enoxaparin slowly until all of the medicine has been injected. Keep pinching the fold of skin while you are injecting.

Step 7: Keep the plunger pressed down while pulling the needle out of the skin. When the needle is out, let go of the skin fold but keep hold of the plunger.

If there is any oozing of blood at the injection site, apply gentle pressure. Do not rub the injection site as this may encourage bruising.

Step 8: Push down plunger further. This will activate the protective needle cover.

Dispose of the syringe in the yellow sharps bin provided. Keep your sharps bin out of reach of other people.

What should I do with my sharps bin once it is three-quarters full?

Once your sharps bin is three-quarters full close it securely then:

If you live in East Sussex:

Please contact your local council for collection, safe disposal, and replacement of sharps bins.

If you live in West Sussex:

Please contact Medisort (West Sussex) phone 01903 719 646 for collection, safe disposal, and replacement of sharps bins. Otherwise please contact your local council.

• mark the updated enoxaparin leaflet as for use at Chichester, Worthing, Brighton & Hove and Haywards Heath.
• ask the CMC to update the PDF of the enoxaparin leaflet.

Are there any side effects of enoxaparin that mean I should contact my local Emergency Department (A&E) or doctor immediately if I have them?

Yes. Like all medicines, enoxaparin can have side effects.

• heavy bleeding from a surgical wound or injection sites
• a painful rash of spots or patches under the skin which do not go away when you put pressure on them. In white skin these may appear pink or red. In brown or black skin, they may be darker
• a feeling of tenderness and swelling in your stomach
• heavy nose bleeds
• blood in your urine (pee) or stool (poo)
• coughing up or vomiting blood
• sudden severe headache
• bruising of your spine or back pain
• tingling, numbness, or weakness in your legs
• bowel or bladder problems (problems with pooing or peeing)
• unusual bruising of no known cause
• a fall or head injury
• changes in your heartbeat
• an allergic reaction which gives you a rash, swallowing or breathing problems or swelling of your lips, face, throat, or tongue
• any other unusual symptoms.

What should I do if:

• I have had too much or too little enoxaparin?

Call NHS 111 for further advice.

• someone else accidentally injects themselves with my enoxaparin?

Call NHS 111 for further advice.

• I forget to have my injection?

Do take your next dose as usual. You do not need to worry if you forget one injection.

Do not have a double dose on the same day.

Is there anything else I should read about enoxaparin as well as this information?

Yes. Do read the product information in the medication packaging.

Who should I contact if I have any further questions about my enoxaparin treatment after I have read this information?

If you have any further questions about your treatment, please speak to your doctor or community nurse who will be able to help you.