This information leaflet has been given to you because you are starting, or already taking, a medicine, known as enoxaparin. Enoxaparin is part of a group of medicines called anticoagulants. An anticoagulant medicine prevents blood clots forming in your blood vessels by making your blood take longer to clot.
Enoxaparin contains product derived from pigs. If you have any ethical objections to the use of animal products please discuss this with your doctor before using enoxaparin.
Enoxaparin reduces blood clot risk
A blood clot can develop in the large veins of the body, usually in the legs. This is called a deep vein thrombosis (DVT).
Sometimes, a blood clot can break free and travel through your bloods vessels. If a clot lodges in the blood vessels of your lungs it is called a pulmonary embolism (PE). A PE can cause chest pain and difficulty in breathing and, if severe, can cause death. Rarely, a clot may move to the brain and cause a stroke.
After surgery there is an increased risk of blood clots forming. Evidence shows that following some types of surgery, an extended period of treatment with enoxaparin reduces this risk. You will usually need to inject enoxaparin for between 10 and 28 days after your surgery.
Why do I need enoxaparin?
There are lots of reasons why you may be at higher risk of blood clots.
Here are some of the most common ones:
- Age over 40, as the risk increases with age
- Taking any kind of oral contraceptive pill (OCP)
- Taking hormone replacement therapy (HRT)
- Some heart problems
- Severe breathing difficulties
- Varicose veins
- If you have had a DVT before
- If you have a family history of DVT
- If you have previously suffered a stroke
- The type of surgery, such as knee or hip replacement or abdominal surgery
How can I tell if I have a DVT or PE?
Early signs of a deep vein thrombosis (DVT)
When you have a deep vein thrombosis, you may notice any of the following signs in one or both legs:
- Pain or tenderness in the calf or thigh
- Swelling, redness or skin colour changes
- Warmth in your calf or leg
Early signs of a pulmonary embolism (PE)
You are much more likely to notice something is wrong if you have a blood clot in your lungs (PE). You may notice one or more of these signs:
- Chest pain
- Shortness of breath
- Coughing or coughing up blood
- Racing heartbeat or fast pulse
- Rapid breathing
- Feeling feverish (temperature above 38.3 C)
If you think you may have a DVT or PE contact your doctor immediately for advice.
How should I inject enoxaparin?
You need to inject enoxaparin under the skin (a ‘subcutaneous injection’). You should have the injection at the same time every day.
Your nurse or doctor will have shown you how to inject yourself using an enoxaparin syringe. They should also tell you how long treatment will be for. It is important that you know the correct technique before you try to inject yourself. If you are unsure, you should ask your nurse or doctor for advice.
Step-by-step instructions for injecting enoxaparin
Note: If these instructions are different from those your nurse or doctor has given you, please follow their advice.
1. Wash your hands with soap and water. Dry them thoroughly.
2. Sit or lie in a comfortable position so that you can see the part of your stomach where you are going to inject. It may help if you can prop yourself up with cushions or pillows, either on a bed or in an armchair. Make sure that your safety bin (sometimes known as a ‘sharps bin’) is within reach.
3. Choose an area on either the left or the right side of your stomach. This should be at least 5cm away from your belly button and out towards your sides.
Remember: Do not inject yourself within 5cm of your belly button or around existing scars or bruises. Change the place where you inject each day between the left and right sides of your stomach, depending on the area you last injected.
4. Carefully remove the protective cap from the end of the syringe, taking care not to bend the needle. Throw the needle cap away in your safety bin; you will not need it again. The syringe is pre-filled and ready to use.
5. Hold the syringe in the hand you write with (like a pencil). With your other hand, gently pinch the area of your abdomen between your forefinger and thumb to make a fold in the skin.
Make sure you hold the skin fold throughout the injection.
6. Hold the syringe so that the needle is pointing downwards (vertically at a 90° angle). Insert the full length of the needle into the skin fold.
7. With your finger, press down gently but firmly on the plunger until it stops and the syringe is empty. If you have been advised to inject less than the full contents of a syringe, your nurse or doctor should provide advice on how to do this.
8. Your injection is over and you can now gently pull the needle out, taking care to keep it straight. Do not release the pressure on the plunger. You can now let go of the skin fold.
9. Push hard on the plunger. The needle guard, which is in the form of a plastic cylinder, will be activated automatically and it will completely cover the needle.
10. Keeping the needle pointing down and away from you, drop the used syringe straight into the safety bin. Close the container lid and place the container out of reach of children.
Do not put your hand or any other object in the safety bin to try and move the used syringes around to make more space. If an extra bin is required contact your GP practice for another.
Things to look out for
As with all medicines, enoxaparin can have side effects in some people. Please see the patient information leaflet supplied with your injections for more advice on possible side effects.
The most common effect is that you may be more susceptible to bruising and bleeding than usual. You may also notice mild irritation or other reactions of the skin on your stomach where you have been injecting. These might include redness, pain, small hard bumps (known as nodules) or bleeding into the skin (sometimes called a haematoma).
These effects may be caused by your injection but if they occur some time after an injection. They may also be a sign of infection: if you notice redness, puffiness, warmth, skin discolouration or oozing of the skin near a previous injection, you should contact your nurse or doctor straight away.
If you notice any of the following effects, please contact your nurse or doctor at once:
- Bleeding from your surgical wound
- Any other bleeding – for example, from the skin where you have injected, nosebleeds, blood in your urine (pink or dark brown), blood in your stools (bowel movement), black tarry stools, or if you cough up blood
- Unusual bruising not caused by a blow or any other obvious reason
You should also tell your nurse or doctor if:
- You have a serious fall or head injury
- You notice any other unusual symptoms
Heparin-induced thrombocytopenia (HIT)
Another issue to look out for is heparin-induced thrombocytopenia (HIT). Enoxaparin contains heparin, which in rare cases, can cause a fall in platelets. This typically occurs 5 to 10 days after starting treatment with enoxaparin.
Platelets are a component of blood which are involved in blood clotting to stop bleeding. When there are too few in the blood, this is termed thrombocytopenia and this results in an increased risk of bleeding.
Signs of heparin-induced thrombocytopenia include:
- Weakness or numbness in the arms or legs
- Pain, tenderness, redness, or swelling of the arms or legs
- Flushing, black, reddish, or bluish discoloration of the skin, or a rash or skin sores in the area where the enoxaparin injection was given
- Chest pain or tightness, or fast or troubled breathing
- Fever, chills or sweating
- Slurred speech, increased sleepiness, or problems seeing, talking, thinking or remembering
If you think you may be affected by HIT then contact your doctor immediately for advice. A blood test can then be performed to check if this is occurring.
Do make sure you keep holding the fold of skin on your abdomen until you have completely finished your injection. This will help ensure that the medicine goes into the fatty tissue rather than muscle, which could bruise.
Do alternate the side on which you inject – right one day, left the next.
Do make sure you put your used syringes into the safety bin each time you inject – never leave a used syringe lying around.
Do follow the advice of your nurse or doctor when using your enoxaparin injections
Do try and carry out your injection at the same time every day.
Do look for unusual signs of bleeding, and get assistance if these occur.
Don’t put the syringe down anywhere or touch the needle with anything before you inject – this will help reduce the risk of infection.
Don’t twist off the needle cap, as this could bend the needle.
Don’t inject into bruised or scarred skin or anywhere that might be rubbed by clothing.
Don’t rub the skin after you have injected, as this can
Don’t let anyone else use your enoxaparin syringes.
Don’t put enoxaparin in the fridge or freezer – keep it at room temperature.
Don’t take any of the following medicines while you are using enoxaparin without discussing it with your nurse or a doctor first. (Note that these medications can be used after surgery so check if this is okay with your doctor or nurse):
- Aspirin, or anything containing aspirin
- Pain relievers known as non-steroidal anti-inflammatory drugs (NSAIDS, such as ibuprofen)
Don’t use enoxaparin if you are allergic to enoxaparin or heparin.
Your questions answered
Q. After discharge from hospital who can I contact for help or advice?
A. If you have any concerns or worries you should contact the ward you were discharged from and ask to speak to the nurse in charge.
You should be given a contact number when you are discharged from hospital. Alternatively, contact the hospital switchboard on 0117 950 5050 who will be able to put you through to the ward.
Q. The patient information leaflet that came with enoxaparin advises against using a particular medicine that I am taking. Is this okay?
A. If you have not already been advised by your nurse or doctor that this is okay, then you should contact your nurse or doctor for advice.
Q. Can I inject anywhere other than my stomach?
A. You should ask your nurse or doctor for advice.
Q. Where should I keep the enoxaparin syringes?
A. Unused syringes should be kept in a safe place out of reach of children. Keep them at room temperature, in the box provided and away from light and moisture.
Q. What should I do if there is an air bubble in the syringe?
A. The syringe normally contains an air bubble. You do not need to do anything to remove the air bubble before you inject.
Q. What should I do if I have injected too much enoxaparin?
A. You should contact your nurse or doctor for advice.
Q. What should I do if I miss an enoxaparin injection?
A. You should contact your nurse or doctor for advice.
Q. How can I find out more about enoxaparin?
A. You can read the patient information leaflet in the enoxaparin box.
Q. What should I do with my used syringes?
A. Put used syringes (with the needle point facing down) into the safety or sharps collection bin you have been given. Always keep this out of reach of children.
Never throw a safety bin away with your other household waste.
Collection of your used safety bin can normally be arranged with your local council. This depends on your local council:
For Bristol City Council
Tel: 0117 922 2100
For South Gloucestershire
You can complete an online form to request a sharps collection.
Tel: 01454 868000
For Bath and North East Somerset Council
You can complete an online form to request a sharps collection.
Tel: 01225 394041
For North Somerset
You’ll need to contact your doctor to ask for a sharps collection.
If you live outside these council areas please contact your GP practice or local community pharmacy for advice on clinical waste collection.
This edition published October 2020. Review due October 2022. NBT002719