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Home | Articles | Haematology and Thrombosis | Low Molecular Weight Heparin

Low Molecular Weight Heparin

Last updated 29th June 2023

VTE Prophylaxis

  1. Preferred prophylaxis in Dumfries is Dalteparin 5,000 units
  2. Reduce dose to 2,500 units daily patient <50kg

VTE Treatment

  1. Preferred treatment in Dumfries is Apixaban (see Treatment of VTE page for more information) but LMWH can be used as a second line treatment if Apixaban contraindicated.
  2. Dose dalteparin according to body weight as follows
    Weight (kg)Dose (CrCl >30mL/min)Dose CrCl <30mL/min)
    <467,500 units5,000 units
    46-5610,000 units7,500 units
    57-6812,500 units10,000 units
    69-8215,000 units12,500 units
    83 and over18,000 units15,000 units
  3. LMWH does not normally require any monitoring but consider measuring anti-Xa activity after 2-3 consecutive doses at extremes of body weight and when CC<30ml/min.
  4. Regular monitoring by anti-Xa activity recommended if patient is on long term LMWH and CC <30ml/min.
  5. To measure anti-Xa, send blood in one INR tube 4 hours post dose when target should be 0.5 – 1.0 unit/ml

Acute Coronary Syndrome

  1. Start immediate treatment with aspirin 300mg stat then 75mg daily, ticagrelor 180mg stat then 90mg bd.
  2. Also, give fondaparinux 2.5mg od if CrCl >20mL/min
  3. Use enoxaparin 1mg/kg od if CrCl <20mL/min. Check Anti-Xa levels 3-4 hours after 3rd dose and every 72 hours thereafter. Target levels are 0.5 – 1.0 units/mL
  4. If enoxaparin not available, use dalteparin 100 units / kg bd (rounded to the nearest syringe and maximum of 7,500 units twice daily)

What to do if Patient Bleeds on LMWH

  1. Send one INR tube to Haematology for Anti-Factor Xa Assay, the result of which should be available within the hour.
  2. Immediately after collecting this blood sample give the patient 1mg of Protamine Sulphate per mg of clexane (Enoxaparin) or per 100 units of Fragmin (Dalteparin) by slow IV injection at a rate not exceeding 5mg/min, to a maximum of 50mg of Protamine.
  3. Protamine only partially neutralises LMWH and has biggest benefit if given within 8 hours of last dose.
  4. Repeat APTT and Anti-Factor Xa can be checked 15 minutes after giving the Protamine.
  5. The decision to give further Protamine or 3 units of Fresh Frozen Plasma should be based on the continuing clinical findings, e.g. no improvement in haemorrhage.
  6. NB Protamine may cause hypersensitivity reactions and resus facilities should be available.

Content updated by Alison Crooks