Blood thinning injection pregnancy

Dalteparin

Omudhome Ogbru, PharmD

Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

Charles Patrick Davis, MD, PhD

Dr. Charles “Pat” Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

What is dalteparin injection, and how does it work (mechanism of action)?

Dalteparin is a low molecular weight heparin (LMWH) similar to enoxaparin (Lovenox) and tinzaparin. Dalteparin is used to treat or prevent blood clots and their complications (deep vein thrombosis or DVT and pulmonary embolism or PE). Deep vein thrombosis is the formation of blood clots in veins deep in a muscle, most often in the legs. Deep vein thrombosis may lead to pulmonary embolism, a condition in which a piece of the clot (the embolus) breaks loose and travels through the veins to the lung. In the lung the clot blocks an artery and prevents the part of the lung that is supplied by the artery from working normally. If the artery that is blocked is a large artery, the embolus can cause sudden death. Patients undergoing hip replacement and other major surgery are at increased risk of deep vein thrombosis and pulmonary embolism. Dalteparin, like other LMWHs is derived from breaking heparin into smaller units. Dalteparin prevents clot formation by accelerating the breakdown of clotting factors Xa and IIa (thrombin) by antithrombin III. Unfractionated heparin, unlike LMWHs, also breaks down clotting factors IX, XI, XII, and plasmin. Unlike heparin, the effect of dalteparin does not need to be monitored with blood tests. The FDA approved dalteparin in December 1994.

What brand names are available for dalteparin injection?

Is dalteparin injection available as a generic drug?

GENERIC AVAILABLE: No

Do I need a prescription for dalteparin injection?

What are the side effects of dalteparin injection?

The most frequent adverse reactions are:

An immune reaction resulting in a drop in platelets and clotting (heparin-induced thrombocytopenia) is very rare, and significantly lower than with heparin use. LMWHs should be avoided in patients with epidural or spinal punctures as there is significant risk of spinal or epidural hematomas resulting in paralysis.

What is the dosage for dalteparin injection?

To prevent blood clots in immobile patients at risk for clots or high risk patients undergoing abdominal surgery or hip replacement, the dose is 5000 units subcutaneously (SQ) once daily. In low risk abdominal surgery patients, the dose is 2500 units SQ once daily. To treat clots in cancer patients, the dose is 200 units per kg weight SQ once daily (max 18,000 units) for month 1, followed by 150 units per kg weight SQ once daily (max 18,000 units) during months 2 to 6. To treat clots in unstable angina or heart attack, the dose is 120 units per kg weight (max 10,000 units) every 12 hours.

Which drugs or supplements interact with dalteparin injection?

Combining dalteparin with other blood thinning agents may increase the risk of severe bleeding. Dalteparin should not be combined with urokinase or other anticoagulants such as apixaban (Eliquis), dabigatran (Pradaxa) and rivaroxaban (Xarelto). Therapy should be monitored when used with platelet inhibitors (such as aspirin and clopidogrel [Plavix]), serotonin reuptake inhibitors (such as sertraline [Zoloft] and fluoxetine [prozac, Sarafem, Prozac Weekly]), and nonsteroidal anti-inflammatory drugs (such as ibuprofen). Dalteparin may increase potassium levels, so caution with and monitoring of potassium levels is advised with drugs such as ACE inhibitors (for example, lisinopril [Zestril, Prinivil]), angiotensin II receptor blockers (for example, losartan [Cozaar]), and other drugs like aliskiren, spironolactone (Aldactone), eplerenone, and potassium salts.

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Is dalteparin injection safe to take if I’m pregnant or breastfeeding?

Adverse effects were not observed in animal studies, as LMWHs do not cross the placenta. LMWHs are preferred over unfractionated heparin and warfarin (Coumadin) in women who are pregnant. Agents should be discontinued at least 24 hours before planned delivery.

Dalteparin enters breast milk, though oral absorption by the infant is extremely low. The effect of this low level of exposure on the infant is unknown.

What else should I know about dalteparin injection?

What preparations of dalteparin injection are available?
  • Single-dosed prefilled syringe: 2500 units (u)/0.2 mL, 5000 u/0.2 mL, 7500 u/0.3 mL, 12,500 u/0.5 mL, 15,000 u/0.6 mL, 18,000 u/0.72 mL
  • Single-dose graduated syringe: 10,000 u/mL
  • Multiple dose vial: 95,000 u/9.5 mL, 95,000u/3.8 mL
How should I keep dalteparin injection stored?

Store at room temperature, between 20 C to 25 C (68 F to 77 F).

Melbourne Haematology

Anticoagulation (Blood thinning) in Pregnancy

What is Anticoagulation?

There are a number of medical conditions where blood is “too thick”. Sometimes these conditions are associated with blood clots forming in the blood vessels. It is sometimes necessary to give patients anticoagulation (blood thinning) to prevent or treat clots that have formed in the blood vessels.

How does blood thinning work?

Blood clots in the circulation by a combination of proteins and cells. Blood thinning generally stops some of the blood clotting proteins from working properly. Blood thinning is usually achieved by either injections with a medication called heparin (Clexane or Fragmin) or by a tablet (Warfarin).

Why do I need to have my blood thinned when I am pregnant?

Blood thinning may be necessary in women who are pregnant for a number of reasons.

These include:

  • Developing a blood clot when pregnant – the treatment for this involves blood thinning during pregnancy
  • Some women have abnormal blood clotting (thicker blood) and need blood thinning when they are pregnant to prevent blood clots; having a baby can make the blood even thicker in some women
  • Women who have abnormal heart valves or artificial heart valves will need blood thinning to prevent blood clots in pregnancy.
  • Are there any side effects of blood clotting I need to worry about in pregnancy?

    Blood thinning is generally safe but there are a number of important precautions to take in pregnancy. One of the blood thinning medications (Warfarin) can sometimes cause problems in the baby – it is important to stop warfarin before getting pregnant or at least to stop warfarin as soon as you become pregnant. Warfarin can sometimes interfere with normal bone growth in babies. Heparin injections are safer for the baby because this medication does not cross the placenta into the baby’s circulation. If you are already on Warfarin and you think you may be pregnant, it is a good idea to do an early pregnancy test and stop the Warfarin as soon as possible.

    Usually, warfarin should not be used when you are pregnant. Heparin injections can be used safely throughout the pregnancy but require you to inject yourself every day.

    Is there anything else I can do?

    It is important that the heparin injections (Clexane) are monitored when you are pregnant so your blood thinning is at the right level. This will make sure your blood is not too thin which can cause bleeding or not thin enough which can cause blood clots.

    It is also important to maintain a healthy weight during pregnancy and to exercise a little – this reduces the risk of blood clots developing.

    What happens around the time I have the baby? Do I have to stop the blood thinning?

    This depends on why you are having blood thinning – sometimes it is safe for you to stop the blood thinning 2 – 3 days before you plan to have the baby. Other times it may be necessary for you to come into hospital to have a different sort of blood thinning which can be stopped immediately before you have your baby. It is best you discuss this with your doctor.

    What happens after I have my baby?

    It is usual for women who need blood thinning when pregnant to need blood thinning for a short time (usually 6 weeks) after delivery. The type and duration of blood thinning will depend on your medical condition.

    Is it safe to breast feed when on blood thinning?

    The blood thinning medication (both heparin injections and Warfarin) are not found in breast milk and so breast feeding is safe whilst on blood thinning.

    Resources used to produce this information sheet.

  • Bates SM, Greer IA, Hirsh J, Ginsberg JS. Use of antithrombotic agents during pregnancy: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126(3 Suppl):627S-644S.
  • FURTHER QUESTIONS?

    The information presented in this fact sheet is intended as a general guide only. Patients should seek further advice and information about Anticoagulation (blood thinning) in pregnancy and their individual condition from their treating haematologist or doctor.

    Heparin injection

    Heparin sodium injection is a type of medicine called an anticoagulant. It is used to stop blood clots forming within the blood vessels. Heparin sodium is sometimes referred to as standard or unfractionated heparin.

    What is heparin injection used for?

    • Treating and preventing blood clots in the veins of the leg (deep vein thrombosis).
    • Treating and preventing blood clots travelling to the lungs (pulmonary embolism).
    • Treating blood clots in the coronary arteries in unstable angina.
    • Treating blood clots that are blocking a peripheral artery, eg in the leg (peripheral arterial occlusion).
    • Preventing further blood clots in the heart immediately following a heart attack.
    • Preventing blood from clotting when it is filtered through an ‘artificial kidney’ (haemodialysis) machine as part of the management of kidney failure.
    • Preventing blood from clotting when it is filtered through a machine during heart-lung bypass surgery.

    How does heparin injection work?

    Heparin sodium injection is a type of medicine called an anticoagulant. It is used to stop blood clots forming within the blood vessels. Heparin sodium is sometimes referred to as standard or unfractionated heparin.

    Blood clots normally only form to stop bleeding that has occurred as a result of injury to the tissues. The clotting process is complicated and begins when blood cells called platelets clump together and produce chemicals that activate the clotting process. The final part of this process involves a substance called thrombin being activated to produce a protein called fibrin. Fibrin binds the platelets together, forming a blood clot. This is the body’s natural way of repairing itself.

    Heparin works by inactivating thrombin in the clotting process. This stops the formation of fibrin and so stops blood clots forming. Heparin is used to treat blood clots that have formed abnormally inside the blood vessels. It can also be used to prevent these types of dangerous blood clots.

    A blood clot that forms abnormally within the blood vessels is known as a thrombus. It can be dangerous because the clot may detach and travel in the bloodstream (where it becomes known as an embolus) and may eventually get lodged in a blood vessel, thereby blocking the blood supply to a vital organ such as the heart, brain or lungs. This is known as a thromboembolism.

    Some people have an increased tendency for blood clots to form within the blood vessels. This is usually due to a disturbance in the blood flow within the blood vessels. For example, in coronary artery disease, fatty deposits (atherosclerosis) on the walls of the coronary arteries can disrupt the blood flow, giving a tendency for platelets to clump together and start off the clotting process. Unstable coronary artery disease means that a furred up bit of the artery has ruptured and a clot has formed on it, reducing the flow of blood to the heart. This causes chest pain (angina) and can result in a heart attack.

    Slow blood flow in the leg and pelvic veins can also result in clots forming in these blood vessels (deep vein thrombosis). These clots can break off and travel to the lungs (pulmonary embolism). Being immobile for long periods of time, for example due to a severe medical condition or following surgery, can increase the risk of these types of blood clot, as can pregnancy, obesity and certain blood disorders.

    How is heparin injection given?

    Heparin is given by injection or drip into a vein (intravenously) or by injection under the skin (subcutaneously) to treat and prevent these types of blood clots. The dose and length of treatment used will depend on the nature of the clot being treated or prevented.

    Important information about heparin injection

    • While you are receiving treatment for a blood clot with this medicine you will need to have regular blood tests, usually on a daily basis, to check the length of time it takes your blood to clot. This is so that your dose can be adjusted to ensure that the lowest effective dose is used at all times, thus reducing the risk of bleeding.
    • If you receive this medicine for longer than five days you will need to have regular blood tests to check the level of blood cells called platelets in your blood. This is because heparin can sometimes cause the number of platelets in your blood to fall – a condition known as thrombocytopenia. If this happens, the heparin will need to be stopped and alternative treatment used.
    • The amount of potassium in your blood will also be checked in the blood tests, particularly if you have been receiving heparin for longer than seven days. This is because heparin can sometimes cause the amount of potassium in your blood to rise too high. This is called hyperkalaemia. Some people may be at a greater risk of this, for example those with diabetes or kidney problems, or people taking other medicines that can cause potassium to be retained in the body.

    Heparin injection should be used with caution in

    • Elderly people
    • Decreased liver function
    • Decreased kidney function
    • Chronic kidney failure
    • Diabetes mellitus
    • High level of potassium in the blood (hyperkalaemia)
    • Increase in the acidity of the blood (metabolic acidosis)
    • Hypersensitivity to low molecular weight heparins, eg dalteparin.

    Heparin injection should not be used in

    • People with low numbers of blood cells called platelets in their blood (thrombocytopenia)
    • People who have previously developed a reduced platelet count due to treatment with heparin (heparin-associated thrombocytopenia)
    • People who are actively bleeding
    • People who are more prone to bleeding than normal, eg due to the blood clotting disorder haemophilia
    • Peptic ulcer
    • Very high blood pressure (severe hypertension)
    • Bacterial infection of the heart valves and the lining surrounding the heart (bacterial endocarditis)
    • People who have recently had bleeding in the brain (cerebral haemorrhage), eg a haemorrhagic stroke
    • People who have had recent injury or surgery to the brain, spinal cord, or eyes
    • People who are due to have spinal or epidural anaesthesia or lumbar puncture
    • Severe liver disease.

    This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

    If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

    Pregnancy and breastfeeding

    Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

    • Heparin is often used to prevent blood clots in pregnant women who are at high risk of clots, for example due to a blood clotting disorder or because they have an artificial heart valve. Heparin does not cross the placenta and so does not enter the baby’s bloodstream. It does not cause birth defects. However, some multidose vials of heparin contain benzyl alcohol and this should be avoided during pregnancy. Long-term use of heparin during pregnancy can cause weakening of the mother’s bones (osteoporosis). There may also be an increased risk of bleeding during the pregnancy, or after delivery. You should discuss this with your doctor. As with all medicines, heparin should only be use during pregnancy if the benefits outweigh any possible risks.
    • Heparin does not pass into breast milk. It can be used safely in mothers who are breastfeeding.

    Possible side effects of heparin injection

    Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

    • Bleeding
    • High blood potassium level (hyperkalaemia)
    • Decrease in the number of platelets in the blood (thrombocytopenia)
    • Breakdown of skin cells
    • Thinning of the bones (osteoporosis) with long term use
    • Hair loss (alopecia) may be experienced after prolonged use
    • Blood clots in the spinal cord (spinal haematoma) in people having spinal or epidural anaesthesia or lumbar puncture while receiving heparin.

    The side effects listed above may not include all of the side effects reported by the medicine’s manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

    If you think you have experienced a side effect from a medicine or vaccine you should check the patient information leaflet. This lists the known side effects and what to do if you get them. You can also get advice from your doctor, nurse or pharmacist. If they think it’s necessary they’ll report it for you.

    You can also report side effects yourself using the yellow card website: www. mhra. gov. uk/yellowcard.

    How can heparin injection affect other medicines?

    It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while having treatment with this one, to ensure that the combination is safe.

    There may be an increased anti-blood-clotting effect, which can result in an increased risk of bleeding or increased time taken to stop bleeding, if any of the following medicines are used in combination with heparin:

    • Antiplatelet (‘blood-thinning’) medicines, such as aspirin, dipyridamole, clopidogrel
    • Clot-busting medicines (fibrinolytics) such as streptokinase, alteplase
    • Dextrans
    • Non-steroidal anti-inflammatory drugs (NSAIDs), such as diclofenac, ibuprofen, naproxen
    • Oral anticoagulants, such as warfarin, nicoumalone, phenindione.

    If you are given any of these your doctor or pharmacist will adjust the doses of your medicines so that the appropriate effect on your blood clotting time is achieved.

    There may an increased risk of a rise in the amount of potassium in your blood if heparin is used in combination with the following medicines, which can also raise blood potassium:

    • ACE inhibitors, eg enalapril, captopril
    • Angiotensin II receptor antagonists, eg losartan, valsartan
    • Potassium-sparing diuretics, eg triamterene, spironolactone, amiloride
    • Potassium supplements
    • Potassium salts.

    The amount of potassium in your blood should be regularly monitored if you are taking any of these while being treated with heparin.

    The anticoagulant effect of heparin may be reduced by drips (intravenous infusions) of nitrate medicines such as glyceryl trinitrate.

    Further reading

    For background information about our medicine factsheets, including the references used to produce them, click here.

    Self-Administered Blood Thinner Injection to Stomach (Post-Op Day 5 RNY/RYGB)

    Injekció beadása bőr alá (subkután, subcutan) otthoni körülmények között.

    Thanks for watching. (RNY/RYGB Gastric Bypass)

    Thanks for watching. (RNY/RYGB Gastric Bypass)

    WLS-focused Pinterest (let me steal your ideas!) – KirstyKirst81

    Surgery performed by Dr. Bruno Dillemans and his team at the hospital AZ Sint-Jan in Brugge, Belgium.

    WLS-focused Pinterest (let me steal your ideas!) – KirstyKirst81

    Surgery performed by Dr. Bruno Dillemans and his team at the hospital AZ Sint-Jan in Brugge, Belgium.

    WLS-focused Pinterest (let me steal your ideas!) – KirstyKirst81

    Surgery performed by Dr. Bruno Dillemans and his team at the hospital AZ Sint-Jan in Brugge, Belgium on 2 Dec 2015.

    WLS-focused Pinterest (let me steal your ideas!) – KirstyKirst81

    Surgery performed by Dr. Bruno Dillemans and his team at the hospital AZ Sint-Jan in Brugge, Belgium.

    WLS-focused Pinterest (let me steal your ideas!) – KirstyKirst81

    WLS-focused Pinterest (let me steal your ideas!) – KirstyKirst81

    Surgery performed by Dr. Bruno Dillemans and his team at the hospital AZ Sint-Jan in Brugge, Belgium.

    WLS-focused Pinterest (let me steal your ideas!) – KirstyKirst81

    Surgery performed by Dr. Bruno Dillemans and his team at the hospital AZ Sint-Jan in Brugge, Belgium.

    My surgery weight: 220 lbs

    My current weight: 211 lbs

    RNY (gastric bypass) on 2 December 2015 in Belgium Europe

    Pureed food & soft foods, head hunger, protein and water status, confession!, cheeseburger time, taco time, sugar-free syrups, cravings, incisions and using peroxide, general physical status, NSVs, online support, and blood thinner injections.

    WLS-focused Pinterest (let me steal your ideas!) – KirstyKirst81

    Surgery performed by Dr. Bruno Dillemans and his team at the hospital AZ Sint-Jan in Brugge, Belgium.

    По материалам:

    Http://www. medicinenet. com/dalteparin_injection/article. htm

    Http://www. melbournehaematology. com. au/fact-sheets/anticoagulation-blood-thinning-in-pregnancy. html

    Http://www. netdoctor. co. uk/medicines/heart-and-blood/a6840/heparin-injection/

    Http://tubethe. com/watch/U2AfbZtK3ho/self-administered-blood-thinner-injection-to-stomach-post-op-day-5-rnyrygb. html

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