Nitrates: anticoagulant effect reduced by infusions of glyceryl trinitrateDrotrecogin alfa: manufacturer advises to avoid use of high doses of heparin with drotrecogin alfaUse with care in patients receiving oral anticoagulants, platelet aggregation inhibitors, aspirin or dextran ADMINISTRATION <\/H3> Reconstition<\/H4>\u2013 Route <\/H4>SC Rate of Administration <\/H4>\u2013Comments<\/H4>\u2013 OTHER INFORMATION <\/H4>In extracorporeal circulation during haemodialysis, 1 mg\/kg enoxaparin is introduced into the arterial line of the Enoxaparin sodium (LMWh).EnoXAPArin sodiUM (LMWh) 265circuit at the beginning of the session. The effect of this dose is usually sufficient for a 4 hour sessionIf fibrin rings are found, a further dose of 0.5\u20131 mg\/kg may be givenFor patients with a high risk of haemorrhage, the dose should be reduced to 0.5 mg\/kg for double vascular access or 0.75 mg\/kg for single vascular accessThe dose of protamine to neutralise the effect of enoxaparin should equal the dose of enoxaparin: 50 anti-heparin units of protamine should neutralise the antifactor-Xa activity generated by 1 mg of enoxaparin. If prothrombin time is still raised 2\u20134 hours later give 0.5 mg\/kg infusion of protamine. (Hovanessian H. Letter. Annals of emergency medicine. 2006; 36(3): 278.)Rhone-Poulenc Rorer advise monitoring of the antifactor-Xa activity, whatever the severity of the renal impairment, when treatment doses are being employed. They also advise monitoring patients if given prolonged treatment with prophylactic dosesLow molecular weight heparins are renally excreted and hence accumulate in severe renal impairment. While the doses recommended for prophylaxis against DVT and prevention of thrombus formation in extracorporeal circuits are well tolerated in patients with ESRF, the doses recommended for treatment of DVT and PE have been associated with severe, sometimes fatal, bleeding episodes in such patients. Hence the use of unfractionated heparin would be preferable in these instancesAdditional doses may be required if using LMWHs for anticoagulation in HDF
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