This reverses most, but not all, of the effects of LMWH. The antidote for LMWH is Protamine sulphate. All cases of LMWH-related alopecia have resolved upon cessation of therapy. The extent of hair loss can vary greatly. If a patient on LMWH develops a major bleed, withhold further doses and seek an urgent Haematology consult. The major adverse event related to treatment with LMWH is bleeding. Please contact the Clinical Haematology department for advice on management around such procedures. For example, if a patient is to have a lumber puncture on Tuesday morning, they should miss their dose of LMWH the night prior to, and morning of, the lumbar puncture. At the Royal Children's Hospital it is recommended that prior to any spinal or epidural procedure, 2 doses of LMWH be omitted. Special note regarding with-holding LMWH prior at time of procedures:Īs with other anticoagulant medications, consideration must be given to the management of LMWH prior to invasive procedures such as lumber punctures and surgery. Avoid intramuscular injections and arterial punctures, if possible. Avoid the use of aspirin as this can increase the risk of bleeding.Ģ. This nomogram assumes there is no bleeding.ġ. Nomogram for dose adjustment of LMWH therapy. Level pre next dose and if not <0.5 units/ml repeat BD.ĭecreased to the nearest whole number as per the LMWH dosing guidelines above

LMWH monitoring table for ongoing/long term anti-Xa monitoring The prescribed dose should be calculated according to Table 1, depending upon the patient’s weight and whether LMWH is indicated for the treatment or prevention of thrombosis.ġ.5mg/kg/BD rounded up to nearest whole numberġmg/kg/BD rounded up to nearest whole numberġmg/kg/BD rounded down to nearest 10mg, capped at 100mg BD Weigh patient and obtain a baseline FBE, APTT, INR and renal function. S = dose available in pre-filled syringe.ġ.

The decision to use LMWH instead of standard heparin or warfarin will depend upon the clinical scenario and individual patient factors such as risk of bleeding or availability of venous access. Low Molecular Weight Heparins are used for the prophylaxis or treatment of deep vein thrombosis. All RCH patients requiring LMWH therapy should be referred to the Clinical Haematology Department.

In neonates and children, the Low Molecular Weight Heparin of choice is 'Enoxaparin' (Clexane) as this is the only LMWH available in Australia that has had paediatric dose-finding studies.

Inr antidote