Heparin and Warfarin - Sydney South West Area Health Service

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Sydney South West Area Health Service Guideline No: SSW_GL2007_010 Date issued: November 2007 • Heparin related thrombocytopenia and thrombosis is an uncommon but potentially serious complication of heparin therapy, requiring urgent review of anticoagulation therapy and consultation with Senior Medical Staff (see below). 2.6 Monitoring • Blood should be taken 4 hours (3-5 hours) after a dose of Enoxaparin for anti-Xa levels. • For twice daily dosing, the therapeutic range is 0.6 - 1.0 IU/ml. • For once daily dosing, the peak anti-Xa level should be 1-2 IU/ml (there is less literature on once daily dosing compared to twice daily dosing). • A full blood count should be checked second daily on inpatients on LMWH therapy, to exclude heparin thrombocytopenia and a fall in haemoglobin to suggest bleeding. In patients receiving extended LMHW heparin therapy as an outpatient (e.g. anticoagulation during pregnancy), it is reasonable to check a full blood count weekly for three weeks and then monthly. • The possibility of a retroperitoneal bleed should be considered in the absence of another identified cause of pain in the back, leg, or abdomen. A full blood count should be performed and reviewed as soon as possible, as well as urgent medical assessment and imaging of the abdomen. • Where the therapeutic intention is anticoagulation for venous thromboembolism, non-steroidal anti-inflammatory drugs (NSAIDs) should be ceased to reduce the risk of bleeding. Reference Hirsh J & Raschke R. The Seventh ACCP Conference on antithrombotic and thrombolytic therapy. Chest. 2004;126:188S-203S The Australasian Creatinine Consensus Working Group. Chronic kidney disease and automatic reporting of estimated glomerular filtration rate: a position statement. Med J Aust 2005; 183: 138-141. 2.7 Charts for estimating GFR: Normal Renal Function: Calculated Creatinine Clearance (eCl CR ) > 60 ml/minute 1 mg/kg twice daily Moderate Renal Impairment: eCl CR = 30 – 60 L/min 1 mg/kg twice daily. Check peak (4 hours after a dose) ant-Xa level day 2 and day 3 of therapy, and every second day after that until stable. Severe Renal Impairment: eCl CR < 30mL/min 1 mg/kg daily. Check peak (4 hours after a dose) ant-Xa level day 2 and day 3 of therapy, and every second day after that until stable. Compliance with this guideline is recommended Page 8 of 24
Sydney South West Area Health Service Guideline No: SSW_GL2007_010 Date issued: November 2007 SERUM CREATININE
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Heparin and Warfarin - Sydney South West Area Health Service

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