East Devon / RD&E only
- Injection syringe 12,5000 units/ml (2,500
- 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
- Dose adjustments are generally unnecessary for obesity or low body weight.
- Reduce dose of dalteparin by 50% if eGFR less than 20ml/min.
North Devon / NDDH only
- Prefilled syringe 2,000 units (20mg), 4,000 units (40mg), 6,000 units (60mg), 8,000 units (80mg), 10,000 units (100mg)
- Clexane® Forte prefilled syringe 12,000 units (120mg), 15,000 units (150mg)
- Clexane® Multidose Vial 30,000 units (300mg)
- Clexane® should be prescribed by brand to prevent confusion and to ensure continuity of supply for patients - see biosimilar products
For use in renal patients
- Prefilled syringe 2500 unit (0.25ml), 3500 unit (0.35ml), 4500 unit (0.45ml)
- Tinzaparin is included for the prevention of clotting in the extracorporeal circuit during haemodialysis in patients with chronic renal insufficiency only.
- Injection 1000 units/ml, 5000 units/ml, 25000 units/ml
- Monitor APTR and adjust as advised by the trust anticoagulation protocol.
- Although a low molecular weight heparin (LMWH) is generally preferred for routine use, a LMWH may not be suitable in the following scenarios:
- Severe renal dysfunction (eGFR less than 20mL/min)
- Massive DVT/PE
- Where extremely rapid onset is deemed appropriate
- 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.
- Injection powder for reconstitution 250mg vial
- See NICE TA230 Bivalirudin for the treatment of ST-segment-elevation myocardial infarction (July 2011)
- Infusion (Flolan®) 500 microgram, 1.5mg
- Epoprostenol is a potent vasodilator and therefore its side-effects include flushing, headache and hypotension.
2. Cardiovascular >
2.8 Anticoagulants and protamine >
2.8.1 Parenteral anticoagulants
- First line
- Second line