2.8.1 Parenteral anticoagulants

Lysine Acetylsalicylate
  • Powder for injection 500mg vial (unlicensed preparation)

Indications

  • Use in intracranial aneurysms

Heparin

South Devon and Torbay patients
Dalteparin Sodium
  • Subcutaneous injection 2,500 units in 0.2ml, 5,000 units in 0.2ml
  • Pre-filled syringe 10,000 units in 0.4ml, 12,500 units in 0.5ml, 15,000 units in 0.6ml, 18,000 units in 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.
Plymouth health community patients
Clexane®

(Enoxaparin)

  • 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/ 3ml (300mg)

Notes

  1. West Devon: refer to individual shared care guidelines for use in Cardiovascular conditions
  2. 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.
  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.
  4. Please refer to UHPNT Guidelines for Venous Thromboembolism (VTE) Prophylaxis in Orthopaedics and Trauma
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.
  2. For use within University Hospitals Plymouth NHS Trust

Unfractionated heparin

Heparin sodium
  • 2 units/ml (1000 units/500ml bags)
  • 10 units/ml (50 units/5ml for I/V flush)
  • 100 units/ml (200 units/2ml for I/V flush – contains preservative)
  • 1000 units/ml (5000 units/5ml amps, 5000 units/5ml vials – contains preservative, 10,000 units/10ml amps, 20,000 units/20ml amps)
  • 5000 units/ml (25,000 units/5ml amps, 25,000 units/5ml vials – contains preservative)
  • 25000 units/ml (5000 units/0.2ml amps, 125,000 units/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 1250 unit/ml, 0.6ml amp (750 units)

Argatroban

Argatroban monohydrate
  • Concentrate for IV infusion 100mg/ml, 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.

 

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