NICE COVID-19 rapid guideline NG200: vaccine-induced thrombocytopenia and thrombosis (VITT) (29 July 2021). This is an evolving area, check the NICE website for the latest guidance. Treatment is on the recommendation of a specialist involving a clinical haematologist. Heparins should be avoided. Please see here

Lysine Acetylsalicylate

• Powder for injection 500mg vial (unlicensed preparation)

Indications

• Use in intracranial aneurysms

Heparins

Dalteparin sodium

• Subcutaneous injection 2,500units/0.2ml, 5,000units/0.2ml
• Pre-filled syringe 10,000units/0.4ml, 12,500units/0.5ml, 15,000units/0.6ml, 18,000units/0.72ml

Notes

1. Dalteparin should be used for prophylaxis and treatment of thromboembolic disorders.
2. Dalteparin should only be prescribed in the community in line with the guidelines in LMWH treatment in IV drug users and pregnant women. It remains a hospital only drug for all other indications.

Clexane

(Enoxaparin)

• Pre-filled syringe 2,000units (20mg), 4,000units (40mg), 6,000units (60mg), 8,000units (80mg), 10,000units (100mg)
• Clexane Forte prefilled syringe 12,000units (120mg), 15,000units (150mg)
• Clexane Multidose vial 30,000units/3ml (300mg)

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.
2. Refer to the BNF or manufacturer's Summary of Product Characteristics (SPC) for dosing regimens
3. Following discharge from hospital, the administration time of enoxaparin may be moved by a maximum of 4 hours to facilitate administration at a convenient regular time by primary care practitioners.

Inhixa

(Enoxaparin)

• Pre-filled syringe 2,000units (20mg), 4,000units (40mg), 6,000units (60mg), 8,000units (80mg), 10,000units (100mg), 12,000units (120mg), 15,000units (150mg)

Indications

• Prophylaxis of venous thromboembolic disease
• Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE)
• Acute coronary syndrome (hospital only)
• Prevention of clotting in extracorporeal circuits (hospital only)

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.
2. Refer to the BNF or manufacturer's Summary of Product Characteristics (SPC) for dosing regimens
3. For an instructional video on the administration of Inhixa and the activation of the PREVENTIS needle shielding system, please click here
4. Following discharge from hospital, the administration time of enoxaparin may be moved by a maximum of 4 hours to facilitate administration at a convenient regular time by primary care practitioners

Tinzaparin sodium

• Pre-filled syringe 2,500units (0.25ml), 3,500units (0.35ml), 4,500units (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

• 2units/1ml (1,000units/500ml bags)
• 10units/1ml (50units/5ml for I/V flush)
• 100units/1ml (200units/2ml for I/V flush – contains preservative)
• 1,000units/1ml (5,000units/5ml amps, 5,000units/5ml vials – contains preservative, 10,000units/10ml amps, 20,000units/20ml amps)
• 5,000units/1ml (25,000units/5ml amps, 25,000units/5ml vials – contains preservative)
• 25,000units/1ml (5,000units/0.2ml amps, 125,000units/5ml vials – contains preservative)

Notes

1. NPSA Rapid Response Report: Risk with Intravenous Heparin Flush Solutions (April 2008): Evidence on heparin flushes indicates no advantage over normal saline for maintaining peripheral intravenous catheters.

Heparinoids

Danaparoid

• Injection 1,250unit/1ml, 0.6ml amp (750units)

Argatroban

Argatroban monohydrate

• Concentrate for IV infusion 100mg/1ml, 2.5ml vial

Notes

1. For use within University Hospitals Plymouth NHS Trust

Hirudins

Bivalirudin

• Injection powder for reconstitution 250mg vial

Notes

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

Heparin flushes

Epoprostenol

• Infusion, powder for reconstitution 500micrograms

Fondaparinux

Fondaparinux

• Injection pre-filled syringe 2.5mg

Notes

1. Fondaparinux is included in the formulary for treatment of acute coronary syndrome (ACS) only. It is not approved for the treatment or prophylaxis of venous thromboembolism. See NICE CG94 Unstable angina and NSTEMI (March 2010) for further information.