Increased risk of haemorrhage with oral anticoagulants or drugs eg. aspirin, dipyradamole that affect platelet function. NSAIDas . dextrans, thrombolytic enzymes, such as streptokinase, high doses of penicillins, and some cephalosoprins, some contrast media, aspriginase and eporosternol, alcohol Hyperkalemia in patients on ACE inhibitors. Reduced activity if given by IV with glyceryl trinitrate. Reduce T1/2 with tobacco

Prophylaxis of post operative venous thromboembolism

Low molecular Weight Heparins- Tinazeparin, Dalteparin, Emoxaparin Refer - LMW - Heparin

Hyperkalemia related to hypoaldosterolism, bleeding, thrombocytopenia, urticarial rash or hypersentivity skin reactions skin necrosis (localised to or distant from the inj site ) increase in transaminases

Do not give by IM. History of thrombocytopenia with heparin positive invitro platelet aggregation test ( cross -reactivity) with parnaparin bacterial endocarditis haemorrhagic CVA , conditions or diseases with increased risk of haemorhage

Special precautions-

Elderly, renal or hepatic impairment, extremes of body weight, hypertension, or other patients with increased risk of bleeding post-op period following brain or spinal cord surgery, special analgesia Pregnancy or lactation

Not recommended for use in patients with prosthetic heart valves as they may not provide adequate prolphylaxis against thromoembolism even at high doses.

Monitor platelet count in long term treatment Do not switch from one brand of LMWH to another durng treatment

Prophylaxis of post operative venous thromboembolism

Dosage-

Adult- for general surgical procedure- As sodium inj of 3200 u 2 hour before procedure followed by 3200u once daily for 7 days or until the patient is fully ambulant.

For higher risk surgery or orthopaedic patients as sodium inj of 4250u 12 hoiur the procedure followed by 4250u units 12 hour post oper and then once daily for 10 days

Contraindicated for use during pregnancy and lactation. Observe caution.