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AI-Generated response:

What are the contraindications for low molecular weight heparin?

Answer generated on June 4, 2024

The AI-generated responses are for illustration purposes only and should not be used for medical purposes.

Low molecular weight heparins (LMWHs) are contraindicated in patients with active major bleeding, history of heparin-induced thrombocytopenia (HIT), hypersensitivity to heparin or pork products, and in certain formulations, hypersensitivity to benzyl alcohol.

  • Active major bleeding is a contraindication due to the increased risk of hemorrhage.[1-3]

  • History of immune-mediated HIT within the past 100 days or in the presence of circulating antibodies is a contraindication.[1-4]

  • Known hypersensitivity to heparin or pork products is a contraindication due to potential allergic reactions.[1-3]

  • Hypersensitivity to benzyl alcohol, which is present in multiple-dose formulations of some LMWHs like enoxaparin, is a contraindication.[1-3]

Additional info

LMWHs, such as enoxaparin and dalteparin, are widely used for thromboprophylaxis and treatment of thromboembolic disorders. However, their use must be carefully considered in patients with contraindications to avoid severe adverse effects. Monitoring for signs of bleeding and thrombocytopenia is crucial during therapy with LMWHs. Additionally, it's important to verify the patient's history for any previous hypersensitivity reactions to heparin products or pork, as these can lead to potentially life-threatening allergic reactions. The presence of benzyl alcohol in certain formulations also necessitates careful patient selection to avoid hypersensitivity reactions. These safety considerations ensure the effective and safe use of LMWHs in clinical practice.

References

Reference 1

1.

Low Molecular Weight Heparins (LMWHs), Elsevier ClinicalKey Drug Class Overview

Content last updated: January 1, 2012.

Safety Issues Table Safety Issues | Dalteparin Sodium | Enoxaparin Sodium ---|---|--- MedGuide | | REMS | | spinal anesthesia | BBW | BBW porcine protein hypersensitivity | X | X lumbar puncture | BBW | BBW heparin-induced thrombocytopenia (HIT) | X | X heparin hypersensitivity | X | X epidural anesthesia | BBW | BBW bleeding | X | X benzyl alcohol hypersensitivity | | X X – Contraindicated X-BBW – Contraindicated and Black Box Warning BBW – Black Box Warning, Not Contraindicated Yes – REMS or MedGuide is available

Bleeding is the major risk associated with use of LMWHs. LMWHs should not be used in patients with severe bleeding disorders, and coagulopathy should be ruled out prior to initiating therapy. The use of LMWH is contraindicated in patients with active major bleeding, and caution is advised when used in patients with any disease state with an increased risk of hemorrhage.

Platelet counts should be monitored in patients receiving LMWHs. If thrombocytopenia occurs, LMWH treatment should be discontinued. LMWHs are contraindicated in patients with HIT or a history of HIT, due to the risk of HIT-associated thrombosis[50262]. [49182]

Reference 2

2.

Food and Drug Administration (DailyMed).

Publish date: January 5, 2022.

Contraindications 4 CONTRAINDICATIONS Enoxaparin sodium is contraindicated in patients with: Active major bleeding History of immune-mediated heparin-induced thrombocytopenia (HIT) within the past 100 days or in the presence of circulating antibodies [see Warnings and Precautions (5.4) ] Known hypersensitivity to enoxaparin sodium (e.g., pruritus, urticaria, anaphylactic/anaphylactoid reactions) [see Adverse Reactions (6.2) ] Known hypersensitivity to heparin or pork products Known hypersensitivity to benzyl alcohol (which is in only the multiple-dose formulation of enoxaparin sodium) [see Warnings and Precautions (5.8) ] Active major bleeding ( 4 ) History of heparin-induced thrombocytopenia (HIT) within the past 100 days or in the presence of circulating antibodies ( 4 ) Hypersensitivity to enoxaparin sodium ( 4 ) Hypersensitivity to heparin or pork products ( 4 ) Hypersensitivity to benzyl alcohol (for multiple-dose formulation only) ( 4 )

Contraindications 4 CONTRAINDICATIONS Enoxaparin sodium injection is contraindicated in patients with: Active major bleeding History of immune-mediated heparin-induced thrombocytopenia (HIT) within the past 100 days or in the presence of circulating antibodies [see Warnings and Precautions ( 5.4 )] Known hypersensitivity to enoxaparin sodium (e.g., pruritus, urticaria, anaphylactic/anaphylactoid reactions) [see Adverse Reactions ( 6.2 )] Known hypersensitivity to heparin or pork products Active major bleeding ( 4 ) History of heparin-induced thrombocytopenia (HIT) within the past 100 days or in the presence of circulating antibodies ( 4 ) Hypersensitivity to enoxaparin sodium ( 4 ) Hypersensitivity to heparin or pork products ( 4 )

Reference 3

3.

Food and Drug Administration (DailyMed).

Publish date: December 5, 2022.

Contraindications 4 CONTRAINDICATIONS Lovenox (enoxaparin sodium) is contraindicated in patients with: • Active major bleeding • History of immune-mediated heparin-induced thrombocytopenia (HIT) within the past 100 days or in the presence of circulating antibodies [see Warnings and Precautions (5.4) ] • Known hypersensitivity to Lovenox (enoxaparin sodium) (e.g., pruritus, urticaria, anaphylactic/anaphylactoid reactions) [see Adverse Reactions (6.2) ] • Known hypersensitivity to heparin or pork products • Known hypersensitivity to benzyl alcohol (which is in only the multiple-dose formulation of Lovenox (enoxaparin sodium)) [see Warnings and Precautions (5.8) ] • Active major bleeding ( 4 ) • History of heparin-induced thrombocytopenia (HIT) within the past 100 days or in the presence of circulating antibodies ( 4 ) • Hypersensitivity to Lovenox (enoxaparin sodium) ( 4 ) • Hypersensitivity to heparin or pork products ( 4 ) • Hypersensitivity to benzyl alcohol (for multiple-dose formulation only) ( 4 )

Reference 4

4.

Elsevier ClinicalKey Drug Monograph

Content last updated: April 5, 2024.

Contraindications And Precautions Dalteparin is contraindicated in patients with a history of heparin-induced thrombocytopenia (HIT) or heparin-induced thrombocytopenia with thrombosis (HITT). Closely monitor for thrombocytopenia of any degree. Although low molecular weight heparins are less likely to trigger formation of HIT antibodies than unfractionated heparin (UFH), LMWHs are just as effective as UFH at triggering platelet activation by HIT antibodies (i.e., LMWHs have essentially 100% in vitro cross-reactivity).

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