Low Molecular Weight Heparin Flashcards
Give an example of a LMWH
Enoxaparin
What is the mechanism of action of LMWB?
Bind to anti-thrombin to form a complex which inactivates clotting factor Xa, which prevents clot formation and reduces VTE risk
What is the route of delivery of LMWH?
SC
What are the indications for LMWH?
- Prophylaxis and treatment of VTE and PE
- MI and unstable ACS
What are the contraindications to LMWH?
- Thrombocytopenia
- Anticoagulant use
What might patients with renal impairment require with LMWH?
Dose adjustment
Who should LMWH be used with caution in?
- Elderly patients
- Patients with hepatic impairment
- Low body weight
What should be done before starting treatment with LMWH?
- Measure FBC (platelets) and U&Es (potassium) before starting treatment
- Calculate creatinine clearance
Why should you calculate creatinine clearance before starting treatment with LMWH?
To ensure patients renal function is appropriate for dose they will be prescribed - if <30ml/min, should be prescribed half dose
What should be done if there is a change in the renal function of a patient on LMWH?
The dose should be reviewed
What should be done if thrombocytopenia occurs in a patient on LMWH?
Discontinue
What might LMWH interact with?
- NSAIDs
- Anticoagulants
- Antiplatelet drugs
What are the common side effects of LMWH?
- Haemorrhage
- Heparin-induced thrombocytopenia
What are the less common side effects of LMWH?
- Hypersensivity and injection site reactions
- Skin necrosis
- Hyperkalaemia
- Alopecia
What counselling is required with LMWH?
- Indication and duration
- Injection technique
- Excessive bleeding
What is LMWH used for?
Temporarily in the first few days of warfarin therapy, before warfarin starts to work
What counselling is required regarding injection technique with LMWH?
Teach patient how to self-inject LMWH and emphasise rotation of injection sites
