• Treatment of venous thromboembolism in pregnancy:
    • Up to 50kg : SC 40 mg BD
    • 50-69kg: SC 60 mg BD
    • 70-89kg: SC 80 mg BD
    • 90kg and over: 100 mg BD
  • Treatment of DVT with/without PE:
    • SC 1 mg/kg/dose BD 
  • Treatment of DVT without PE outpatient:
    • SC 1 mg/kg/dose BD
    • Continue for >5 days and overlap with warfarin until INR 2-3 x24h
  • DVT prophylaxis in moderate risk surgical patients:
    • SC 20 mg x1 given approx. 2 hours before surgery, then 20 mg OD 12 hours post-op *7-10 days 
  • DVT prophylaxis in high risk surgical patients (e.g. orthopedic surgery):
    • SC 40 mg x1 approx. 12 hours before surgery, then 40 mg OD12 hours post-op *7-10 days 
  • DVT prophylaxis in medical patients:
    • SC 40mg OD *6-11 days 
  • Treatment of DVT/PE in uncomplicated patients with low risk of recurrence:
    • SC 1.5mg/kg OD until adequate oral anticoagulation established 
  • Treatment of DVT/PE in patients with risk factors such as obesity, cancer, recurrent VTE or proximal thrombosis:
    • SC 1mg/kg BD until adequate oral anticoagulation established 
  • Treatment of acute ST-segment elevation MI (patients NOT undergoing percutaneous coronary intervention):
    • Adult 18-74 years:
      • Initially IV 30 mg, then SC 1mg/kg x1 then SC 1mg/kg BD (Max.per dose 100 mg) for up to 8 days
      • Max dose applies for the first two SC doses only, then IV 300mcg/kg x1, dose to be given at the time of procedure if the last SC dose was given more than 8 hours previously
  • Adult 75 years and over:
    • SC 750 mcg/kg BD. Max per dose 75 mg
    • Maximum dose applies for the first two doses only
  • Treatment of acute ST-segment elevation MI (patients undergoing percutaneous coronary intervention):
    • Adult 18–74 years:
      • Initially IV 30mg, followed by SC 1 mg/kg x1 dose, 1mg/kg BD. Max per dose 100 mg for up to 8 days
      • Max dose applies for the first two SC doses only, then IV 300 mcg/kg x1.
      • Dose to be given at the time of procedure if the last SC dose was given more than 8 hours previously
  • Adult 75 years and over:
    • SC 750 mcg/kg BD. Max per dose 75 mg
    • Max dose applies for the first two doses only, then IV 300 mcg/kg x1, dose to be given at the time of procedure if the last SC dose was given more than 8 hours previously
  • Unstable angina/Non-ST-segment-elevation MI:
    • Adult: SC 1mg/kg BD usually for 2-8 days. Min 2 days.
  • Thromboembolism in pediatric patients:
    • Prophylaxis:
      • < 2 months: SC 0.75 mg/kg/dose BD
      • ≥2 months: SC 0.5 mg/kg BD 
    • Treatment:
      • <2 months: SC 1.5 mg/kg BD
      • ≥2 months: SC 1 mg/kg BD

Dosing modifications in renal impairment

  • Severe (CrCl <30 mL/min): Dosage reductions required
  • Prophylaxis in high risk surgery: SC 30 mg OD
  • DVT treatment (inpatient or outpatient) coadministered with warfarin: SC 1 mg/kg OD
  • Non-Q-wave MI: SC 1 mg/kg OD
  • Treatment of acute STEMI (<75 years): 30 mg IV single bolus plus 1 mg/kg SC, then SC 1mg/kg OD
  • Treatment of acute STEMI (>75 years): No initial bolus; maintenance SC 1mg/kg OD

Injection:

  • 20mg
  • 40mg
  • 60mg
  • 80mg
  • Discontinue if platelets <100,000
  • For IV administration, may administer in IV line with 0.9% NaCl or D5W
  • Administer deep SC alternating right and left anterior and posterior abdominal walls into skin fold held between thumb and forefinger
  • Watch out for bleeding in low body weight (<45 kg for women or <57 kg for men)

Low Molecular Weight (LMW) Heparin; Anticoagulant

It binds to antithrombin III and accelerates activity, inhibiting thrombin and factor Xa. It also inhibits platelet function, increases proliferation of vascular smooth muscle cells, inhibits delayed hypersensitivity reactions and is involved in regulation of angiogenesis.

  • Hemorrhage
  • Anemia
  • Fever
  • Local site reaction
  • Hematuria
  • Elevated ALT/AST
  • Thrombocytopenia
  • Osteoporosis with long term use
  • Ecchymosis
  • Spinal/epidural hematomas may occur in anticoagulated patients receiving neuraxial anesthesia or spinal puncture resulting in long term or permanent paralysis
  • Active major bleeding
  • Hypersensitivity to compound or heparin
  • Hypersensitivity to pork products
  • History of heparin-induced thrombocytopenia (HIT) within past 100 days or in presence of circulating antibodies
  • Neonates or infants (benzyl alcohol-containing INJ forms)
  • Peptic ulcers
  • Mifepristone
  • Defibrotide

                                   Drug Status

Availability Prescription only
Pregnancy Category B; can be used but caution advised in benzyl alcohol-containing INJ forms
Breastfeeding Can be used
Schedule Not controlled
BRAND NAME STRENGTH FORMULATION PACK SIZE MANUFACTURER DISTRIBUTOR
Bnoxiparin 40mg/0.4mL Injection 1’s Brawn Labs Sai Pharma
Bnoxiparin 60mg/0.6mL Injection 1’s Brawn Labs Sai Pharma
Clexane 20mg/0.2mL Pre-Filled Syringe 2’s Sanofi-Aventis Ressourcethica Kenya
Clexane 40mg/0.4mL Pre-Filled Syringe 2’s Sanofi-Aventis Ressourcethica Kenya
Clexane 60mg/0.6mL Pre-Filled Syringe 2’s Sanofi-Aventis Ressourcethica Kenya
Clexane 80mg/0.8mL Pre-Filled Syringe 2’s Sanofi-Aventis Ressourcethica Kenya
LMW Enox 20mg/0.2mL Pre-Filled Syringe 2’s Glenmark Pharma Glenmark Pharma
LMW Enox 40mg/0.4mL Pre-Filled Syringe 2’s Glenmark Pharma Glenmark Pharma
LMW Enox 60mg/0.6mL Pre-Filled Syringe 2’s Glenmark Pharma Glenmark Pharma
LMW Enox 80mg/0.8mL Pre-Filled Syringe 2’s Glenmark Pharma Glenmark Pharma
Lomoh 40mg/0.4mL Pre-Filled Syringe 1’s Emcure Pharma Lazor Pharma
Lomoh 60mg/0.6mL Pre-Filled Syringe 1’s Emcure Pharma. Lazor Pharma
Lomoh 80mg/0.8mL Pre-Filled Syringe 1’s Emcure Pharma Lazor Pharma
Parin-E 20mg/0.2mL Pre-Filled Syringe 2’s Venus Remedies Surgipharm Ltd
Parin-E 40mg/0.4mL Pre-Filled Syringe 2’s Venus Remedies Surgipharm Ltd
Parin-E 60mg/0.6mL Pre-Filled Syringe 2’s Venus Remedies Surgipharm Ltd
Parin-E 80mg/0.8mL Pre-Filled Syringe 2’s Venus Remedies Surgipharm Ltd
Troynoxa 40mg/0.4mL Pre-Filled Syringe 1’s Troikaa Harley’s Ltd
Troynoxa 60mg/0.6mL Pre-Filled Syringe 1’s Troikaa Harley’s Ltd