Type of Drug:

Low molecular weight heparins (LMWHs); inject able anticoagulants; “blood thinners.

How the Low Molecular Weight Heparins Works:

Low molecular weight heparin’s prevent blood clots from storming. They will not dissolve already-formed blood clots but may keep them from getting bigger and breaking loose embolus).

Uses of Low Molecular Weight Heparins:

Dalteparin, enoxaparin: For the prevention of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE) (blood clots in the lung) in patients undergoing hip replacement surgery (during and following hospitalization), knee replacement surgery (enoxaparin only), abdominal surgery in patients who are at risk for blood clotting complications, or in patients at risk for blood clotting complications due to severely restricted mobility during acute illness (enoxaparin only). Abdominal surgery patients at risk for blood clotting complications include those who are older than 40 years of age, obese, undergoing surgery under general anesthesia lasting longer than 30 minutes, or who have additional risk tractors such as cancer or a history of DVT or PE.

For the prevention of is chemic complications of unstable angina and non-Q-wave myocardial infarction when coadministered with aspirin.

Enoxaparin: In conjunction with warfarin sodium (eg, Coumadin) for inpatient treatment of acute DVT with or without PE or for outpatient treat­mont of acute DVT without PE.

Tinzaparin: In conjunction with warfarin sodium for inpatient treatment of 1cute DVT with or without PE.

Precautions:

Do not use in the following situations: allergy to the drug or any of its ingredients allergy to heparin allergy to pork routable to sulfites (tinzaparin only) bleeding, active major regional anesthesia for unstable angina or non-Q-wave MI (dalteparin only) thrombocytopenia (low platelet count) with positive test for anti platelet antibody

Use with caution in the following situations: antiplatelet agent therapy, high blood pressure, severe and current uncontrolled bleeding disorders hypertension retinopathy diabetic retinopathy kidney disease, severe elderly liver disease, severe mediocrities, bacterial prosthetic heart valves (Lennox gastrointestinal disease paring only) (eg, ulcers or bleeding) stroke, hemorrhagic (bleeding) heparin-induced thrombosurgery, recent (brain, spine, or cytopenia (low platelet levels), eye) history of

• Benzyl alcohol: Some of these products contain benzyl alcohol, which has been linked to fatal “gasping syndrome” in premature infants. Use with caution.

• Sulfites: Some of these products contain sulfite preservatives that can cause allergic reactions in certain individuals (eg, patients with asthma). Consult your doctor or pharmacist.

• Pregnancy: There are no adequate and well-controlled studies in pregnant women. A few spontaneous fetal deaths have been reported in enoxaparin-treated pregnant women with prosthetic heart valves. Use only if clearly needed and the potential benefits outweigh the possible risks to the fetus.

• Breastfeeding: It is not known if these drugs appear in breast milk. Consult your doctor before you begin breastfeeding.

• Children: Safety and effectiveness have not been established.

• Elderly: The risk of enoxaparin-associated bleeding and other serious side effects increases with age. Elimination of enoxaparin is delayed in elderly patients. Use with caution.

• Lab Tests: Lab tests may be required to monitor therapy. Tests may include complete blood counts, urinalysis, neurological tests, and stool occult blood tests.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any over­the-counter or prescription medications or dietary supplements while taking these drugs. Drug doses may need to be modified or a different drug prescribed. The following drugs and drug classes interact with these drugs:

• Anticoagulants, oral (eg, warfarin)

• Platelet inhibitors (eg, aspirin and other salicylates, dipyridamole, NSAIDs, sulfinpyrazone, dextran, ticlopidine)

Side Effects of Low Molecular Weight Heparins:

Every drug is capable of producing side effects. Many patients experience no, or minor, side effects. The frequency and severity of side effects depend upon many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

• Digestive Tract: Constipation; nausea; vomiting; stomach pain; diarrhea; gas; indigestion.

• Circulatory System: Changes in blood pressure; chest pain; abnormal heart rhythm; anemia; fast heartbeat.

• Nervous System: Dizziness; sleeplessness; confusion; headache. Urinary and Reproductive Tract: Blood in the urine; urinary tract infection; difficult or painful urination.

Other: Pain, redness, hardness, or bruising at the injection site; heavy or unusual bleeding or bruising; black stools; fever; swelling of the arms or legs; abnormal blood counts; lab test abnormalities; fever; difficulty breathing; pneumonia; nosebleed; back pain; impaired hearing; pain; infection; rash.

Guidelines for Use:

• Dosage is individualized. Use exactly as prescribed.
• Do not stop taking or change the dose, unless instructed by your doctor.
• Follow the storage, preparation, administration, and disposal techniques taught to you by your health care provider.
• This medicine is administered once or twice daily. When it is started and how long therapy lasts depends on many factors, including the condition being treated. Your health care provider will advise you on how often to administer and for how long.
• Administer subcutaneously (SC; beneath the skin) only; do not administer intramuscularly (1M; into a muscle) or intravenously (IV; into a vein). Injections are given around the navel, upper thigh, or buttocks; change the injection site with each dose.
• If a dose is missed, inject as soon as possible. If more than 6 hours have passed or it is nearing time for the next dose, do not double the dose to catch up, unless instructed by your doctor. If more than one dose is missed or it is necessary to establish a new dosing schedule, contact your doctor or pharmacist.
• Do not rub or massage the injection site after completing the injection. Excessive bruising may occur. If bruising does occur, it may be lessened by an ice cube massage of the site prior to injection.
• Contact your doctor if you experience bleeding, unusual bruising, dizziness, light-headedness, itching, rash, fever, swelling of the arms or legs, or difficulty breathing.
• Low molecular weight heparin’s are not interchangeable with each other or with heparin. Each of these medicines has its own instructions for use.
• Lab tests may be required to monitor therapy. Be sure to keep appointments.
• Do not use if solution is discolored or contains particles.
• Store at controlled room temperature (59° to 77° F for Lennox, alteration; 59° to 86°F for inspiring).