page163
Hepatic impairment
manufacturer advises caution—
no information available
Renal impairment
risk of bleeding increased;
reduce
dose if eGFR less than 30 mL/minute/1.73 m
2
—
consult product literature for details;
monitoring of
anti-factor Xa may be required; use of unfractionated
heparin may be preferable
Pregnancy
not known to be harmful; see also
Pregnancy,
p.
140
Breast-feeding
manufacturer advises avoid—no
information available
Side-effects
see under Heparin
Dose
. See under preparation below
Clexane
c
(Sanofi-Aventis) A
Injection
,
enoxaparin sodium 100 mg/mL,
net price
20-mg (0.2-mL,
2000-units) syringe = £3.03,
40-mg
(0.4-mL,
4000-units) syringe = £4.04,
60-mg (0.6-mL,
6000-units) syringe = £4.57,
80-mg (0.8-mL,
8000-
units) syringe = £6.49,
100-mg (1-mL,
10 000-units)
syringe = £8.04;
300 mg (3-mL,
30 000-units) vial
(
Clexane
c
Multidose
) = £21.33;
150 mg/mL
(
Clexane
c
Forte
),
120-mg (0.8-mL,
12 000-units)
syringe = £9.77,
150-mg (1-mL,
15 000-units) syringe
= £11.10
Excipients
include benzyl alcohol (in 300 mg multidose vials) (avoid in
neonates,
see Excipients, p.
2)
Dose
prophylaxis of deep-vein thrombosis especially in surgical
patients,
by subcutaneous injection,
moderate risk
,
20 mg
(2000 units) approx.
2 hours before surgery then 20 mg
(2000 units) every 24 hours;
high risk
(e.g.
orthopaedic surgery),
40 mg (4000 units) 12 hours before surgery then 40 mg
(4000 units) every 24 hours
Prophylaxis of deep-vein thrombosis in medical patients,
by
subcutaneous injection,
40 mg (4000 units) every 24 hours
Treatment of deep-vein thrombosis or pulmonary embolism,
by
subcutaneous injection
, 1.5 mg/kg (150 units/kg) every 24 hours
until
adequate oral
anticoagulation established
Treatment of acute ST-segment elevation myocardial infarction,
ADULT under 75 years, by intravenous injection,
30 mg
(3000 units) followed
by subcutaneous injection,
1 mg/kg
(100 units/kg), then by subcutaneous injection, 1 mg/kg every 12
hours for up to 8 days (max.
100 mg (10 000 units) for first two
subcutaneous doses only);
ELDERLY over 75 years,
by subcuta-
neous injection
only
,
750 micrograms/kg (75 units/kg) every 12
hours (max.
75 mg (7500 units) for first two doses only);
patients
undergoing percutaneous coronary intervention, additional dose,
by intravenous injection,
300 micrograms/kg (30 units/kg) at
time of procedure if last subcutaneous dose given more than 8
hours previously
Note
When administered in conjunction with a thrombolytic,
enoxaparin should be given between 15 minutes before and 30
minutes after the start of thrombolytic therapy
Unstable angina and non-ST-segment-elevation myocardial
infarction,
by subcutaneous injection,
1 mg/kg (100 units/kg)
every 12 hours usually for 2–8 days (minimum 2 days)
Prevention of clotting in extracorporeal circuits,
consult product
literature
Treatment of venous thromboembolism in pregnancy [unlicensed
indication],
by subcutaneous injection,
early pregnancy body-
weight under 50 kg, 40 mg (4000 units) twice daily;
body-weight
50–70 kg, 60 mg (6000 units) twice daily;
body-weight 70–90 kg,
80 mg (8000 units) twice daily;
body-weight over 90 kg, 100 mg
(10 000 units) twice daily
TINZAPARIN SODIUM
Indications
see notes above and under preparations
Cautions
see under Heparin and notes above
Contra-indications
see under Heparin
Hepatic impairment
manufacturer advises avoid in
severe impairment
Renal impairment
risk of bleeding may be
increased—dose reduction,
and monitoring of anti-
Factor Xa may be required; use with caution in elderly
and avoid if age over 90 years; unfractionated heparin
may be preferable
Pregnancy
not known to be harmful; vials contain
benzyl alcohol—manufacturer advises avoid; see also
Pregnancy,
p.
140
Breast-feeding
manufacturer advises avoid—no
information available
Side-effects
see under Heparin
Dose
. See under preparations below
Innohep
c
(LEO) A
Injection
,
tinzaparin sodium 10 000 units/mL, net
price 2500-unit (0.25-mL) syringe = £1.98,
3500-unit
(0.35-mL) syringe = £2.77,
4500-unit (0.45-mL)
syringe = £3.56,
20 000-unit (2-mL) vial = £10.56
Excipients
include benzyl alcohol (in vial) (avoid in neonates,
see Exci-
pients,
p.
2)
Dose
prophylaxis of deep-vein thrombosis,
by subcutaneous
injection, general surgery, 3500 units 2 hours before surgery, then
3500 units every 24 hours;
orthopaedic surgery,
50 units/kg 2
hours before surgery,
then 50 units/kg every 24 hours
or
4500 units 12 hours before surgery, then 4500 units every 24 hours
Prevention of clotting in extracorporeal circuits,
consult product
literature
Injection
,
tinzaparin sodium 20 000 units/mL, net
price 0.5-mL (10 000-unit) syringe = £8.46,
0.7-mL
(14 000-unit) syringe = £11.85,
0.9-mL (18 000-unit)
syringe = £15.23,
2-mL (40 000-unit) vial = £34.20
Excipients
include benzyl alcohol (in vial) (avoid in neonates,
see Exci-
pients,
p.
2),
sulphites (in 20 000 units/mL vial and syringe)
Dose
treatment of deep-vein thrombosis and of pulmonary
embolism,
by subcutaneous injection,
175 units/kg once daily
until
adequate oral
anticoagulation established
Treatment of venous thromboembolism in pregnancy [unlicensed
indication],
by subcutaneous injection,
175 units/kg once daily
(based on early pregnancy body-weight)
Note
Treatment
regimens do not
require anticoagulation mon-
itoring
Heparinoids
Danaparoid is a heparinoid used for
prophylaxis of
deep-vein thrombosis in patients undergoing general
or orthopaedic surgery.
Providing there is no evidence
of
cross-reactivity,
it
also has a role in patients who
develop heparin-induced thrombocytopenia.
DANAPAROID SODIUM
Indications
prevention of deep-vein thrombosis in
general or orthopaedic surgery;
thromboembolic dis-
ease in patients with history of heparin-induced
thrombocytopenia
Cautions
recent bleeding or risk of bleeding;
conco-
mitant use of drugs that increase risk of bleeding;
antibodies to heparins (risk of antibody-induced
thrombocytopenia);
body-weight over 90 kg (monitor
anti factor Xa activity)
Contra-indications
haemophilia and other haemor-
rhagic disorders,
thrombocytopenia (unless patient
has heparin-induced thrombocytopenia),
recent
cerebral haemorrhage,
severe hypertension,
active
peptic ulcer (unless this is the reason for operation),
diabetic retinopathy,
acute bacterial endocarditis,
spinal or epidural anaesthesia with treatment doses of
danaparoid
Hepatic impairment
caution in moderate impairment
(increased risk of bleeding);
avoid in severe impair-
ment unless patient has heparin-induced thrombocy-
topenia and no alternative available
BNF 61
2.8.1 Parenteral anticoagulants
143
2
Cardiovascular system