2.8.1 Parenteral anticoagulants

Heparins

East Devon / RD&E only
Dalteparin
  • Injection syringe 12,5000 units/ml (2,500 units/0.2ml)
  • Injection syringe 25,000 units/ml (5,000 units/0.2ml), (7,500 units/0.3ml), (10,000 units/0.4ml), (12,500 units/0.5ml), (15,000 units/0.6ml), (18,000 units/0.72ml)
  • Injection amp 2,500 units/ml (10,000 units/4ml), 25,000 units/ml, (100,000 units/4ml)
  • Injection graduated syringe 10,000 units/ml

Notes

  1. Dose adjustments are generally unnecessary for obesity or low body weight.
  2. Reduce dose of dalteparin by 50% if eGFR less than 20ml/min.
North Devon / NDDH only
Clexane®

(Enoxaparin)

  • Prefilled syringe 2,000 units (20mg), 4,000 units (40mg), 6,000 units (60mg), 8,000 units (80mg), 10,000 units (100mg)
  • Multidose vial 30,000 units (300mg)
  • Clexane® Forte prefilled syringe 12,000 units (120mg), 15,000 units (150mg)

Notes

  1. Prescribe by brand. Biological medicines (including biosimilar medicines) must be prescribed by brand name and the brand name specified on the prescription should be dispensed in order to avoid inadvertent switching, to prevent confusion and to ensure continuity of supply for patients. A biosimilar medicine is a biological medicine that is highly similar and clinically equivalent (in terms of quality, safety, and efficacy) to an existing biological medicine however they cannot be considered generic equivalents of the originator biological medicine. Because they are not identical, biological medicines must be prescribed by brand. The decision which brand to prescribe rests with the responsible clinician in consultation with the patient. Automatic substitution of brands at the point of dispensing is not appropriate for biological medicines.
For use in renal patients
Tinzaparin sodium
  • Prefilled syringe 2500 unit (0.25ml), 3500 unit (0.35ml), 4500 unit (0.45ml)

Notes

  1. Tinzaparin is included for the prevention of clotting in the extracorporeal circuit during haemodialysis in patients with chronic renal insufficiency only.

Unfractionated heparin

Heparin sodium
  • Injection 1000 units/ml, 5000 units/ml, 25000 units/ml

Notes

  1. Monitor APTR and adjust as advised by the trust anticoagulation protocol.
  2. Although a low molecular weight heparin (LMWH) is generally preferred for routine use, a LMWH may not be suitable in the following scenarios:
    1. Severe renal dysfunction (eGFR less than 20mL/min)
    2. Massive DVT/PE
    3. Where extremely rapid onset is deemed appropriate
    4. Where there is a high risk of haemorrhage that may require rapid reversal

Unfractionated heparin may be appropriate in these circumstances, but close laboratory and clinical monitoring is essential.

Hirudins

Bivalirudin
  • Injection powder for reconstitution 250mg vial

Notes

  1. See NICE TA230 Bivalirudin for the treatment of ST-segment-elevation myocardial infarction (July 2011)

Heparin flushes

Epoprostenol
  • Infusion 500 microgram, 1.5mg

Notes

  1. Epoprostenol is a potent vasodilator and therefore its side-effects include flushing, headache and hypotension.

Fondaparinux

Fondaparinux
  • Injection pre-filled syringe 2.5mg

Notes

  1. Fondaparinux is included in the formulary for treatment of acute coronary syndrome (ACS)

 

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