2.8 Anticoagulants and protamine

Related Documents: Anticoagulation - Best Practice

See notes below on choice of low molecular weight heparins (LMWH)

2.8 Anticoagulants and protamine
Dalteparin sodium injection	R	Renal Unit haemodialysis only
Epoprostenol infusion vial 500mcg	F	Renal Unit/ICU/Respiratory Medicine/ Vascular Surgery
Enoxaparin syringes 20mg, 40mg, 60mg, 80mg, 100mg, 120mg, 150mg	F	See notes below
Heparin calcium preparations	F
Heparin sodium preparations	F
Hepsal solution 50u/5ml *	F
Acenocoumol (Nicoumalone) tablets 1mg	F
Warfarin tablets 1mg, 3mg, 5mg	F	1mg tablets will be supplied wherever possible

* Hepsal solution is only to be used to flush cannula sites which have been in place for more than 48 hours.  For cannulas in place less than 48 hours, sodium chloride injection 0.9% is as effective for maintaining catheter patency.  Hepsal should be used for central lines and in children.

Prophylaxis of thromboembolic disorders 

Low molecular weight heparins are as effective and safe as unfractionated heparin, and appear to be more effective in orthopaedic surgery. They are advantageous in that only one sub-cutaneous injection is required daily, instead of two or three with conventional heparin.  No monitoring is required for prophylaxis. 

Low to moderate risk patients e.g. general surgery, should receive 2,000 units (20mg) enoxaparin 2 hours preoperatively, then once daily for 7 to 10 days or until the risk of thromboembolism has diminished. 

Higher risk patients e.g. orthopaedic surgery, should receive 4,000 units (40mg) enoxaparin 12 hours preoperatively, then once daily as above.

2.8.3 Protamine sulphate
Protamine sulphate Inj 50mg	F
Haematology/Pharmacy are able to advise on its use

Unstable angina and non-ST-elevation myocardial infarction (Acute Coronary Syndrome)