LMWH

Question 1

Facts on LMWH

Answer 1

• Monitoring of anti-Xa levels is not required when LMWH is used for thromboprophylaxis
• Doses of LMWH should be reduced in women with renal impairment (creatinine clearance 30 ml/min with deltaparin and 20 ml/min with tinzaparin) equals a creatinine of 200 mcmol/l in a 30 year old weighing 70 Kg

Question 2

Suggested quantities of Enoxaparin prophylaxis

higher doses BD

Answer 2

• 170 Kg: 0.5/kg/day

Question 3

Suggested quantities of Dalteparin prophylaxis

higher doses BD

Answer 3

• 170 Kg: 75/Kg/day u

Question 4

Suggested quantities of Tinzaparin prophylaxis

higher doses BD

Answer 4

• 170 Kg: 75/Kg/day u

Question 5

Unfractionated heparin

Answer 5

• High risk of bleeding
• Check plts every 2–3 days from days 4–14 or until heparin is stopped
• The benefits of UFH: shorter half-life than LMWH and there is more complete reversal of its activity by protamine sulfate
• Interval between UFH and regional is only 4 hours and less risk of haematomas

Question 6

Danaparoid/ Fundaxaparin

Answer 6

Limited for women intolerant of heparin

Question 7

Warfarin

Answer 7

• Only in pregnancy if absolutely necessary
• Safe to breastfeed
• Convert back to warfarin day 5-7 post delivery
• Warfarin embryopathy :hypoplasia of nasal bridge, congenital heart defects, ventriculomegaly, agenesis of the corpus callosum, stippled epiphyses
• approximately 5% of fetus 6-12 weeks
• dose dep for > 5 mg/day

Question 8

Anti embolic stockings

Answer 8

Pressure of 14-15 mmHg