BNF for Children 2011-2012

BNFC 2011–2012 2.8.1 Parenteral anticoagulants 117Breast-feeding see notes aboveSide-effects see under HeparinLicensed use not licensed for use in childrenIndication and doseTreatment of thrombotic episodes. By subcutaneous injectionNeonate 1.5–2 mg/kg twice dailyChild 1–2 months 1.5 mg/kg twice dailyChild 2 months–18 years 1 mg/kg twice dailyTreatment of venous thromboembolism inpregnancy. By subcutaneous injectionChild 12–18 years early pregnancy body-weightunder 50 kg, 40 mg (4000 units) twice daily; bodyweight50–70 kg, 60 mg (6000 units) twice daily;body-weight 70–90 kg, 80 mg (8000 units) twicedaily; body-weight over 90 kg, 100 mg(10 000 units) twice dailyProphylaxis of thrombotic episodes. By subcutaneous injectionNeonate 750 micrograms/kg twice dailyChild 1–2 months 750 micrograms/kg twice dailyChild 2 months–18 years 500 micrograms/kgtwice daily; max. 40 mg dailyClexane c (Sanofi-Aventis) AInjection, enoxaparin sodium 100 mg/mL, net price20-mg (0.2-mL, 2000-units) syringe = £3.03, 40-mg(0.4-mL, 4000-units) syringe = £4.04, 60-mg (0.6-mL,6000-units) syringe = £4.57, 80-mg (0.8-mL, 8000-units) syringe = £6.49, 100-mg (1-mL, 10 000-units)syringe = £8.04, 300-mg (3-mL, 30 000-units) vial(Clexane c Multi-Dose) = £21.33; 150 mg/mL(Clexane c Forte), 120-mg (0.8-mL, 12 000-units)syringe = £9.77, 150-mg (1-mL, 15 000-units) syringe= £11.10Excipients include benzyl alcohol (in 300 mg multidose vials) (avoid inneonates, see, p. 2)TINZAPARIN SODIUMCautions see under Heparin and notes aboveContra-indications see under HeparinHepatic impairment see notes aboveRenal impairment risk of bleeding may beincreased—dose reduction and monitoring of anti-Factor Xa may be required; unfractionated heparinmay be preferablePregnancy see notes above; also vials contain benzylalcohol—manufacturer advises avoidBreast-feeding see notes aboveSide-effects see under HeparinLicensed use not licensed for use in childrenIndication and doseTreatment of thrombotic episodes. By subcutaneous injectionChild 1–2 months 275 units/kg once dailyChild 2 months–1 year 250 units/kg once dailyChild 1–5 years 240 units/kg once dailyChild 5–10 years 200 units/kg once dailyChild 10–18 years 175 units/kg once dailyTreatment of venous thromboembolism inpregnancy. By subcutaneous injectionChild 12–18 years 175 units/kg once daily (basedon early pregnancy body-weight)Prophylaxis of thrombotic episodes. By subcutaneous injectionChild 1 month–18 years 50 units/kg once dailyInnohep c (LEO) AInjection, tinzaparin sodium 10 000 units/mL, netprice 2500-unit (0.25-mL) syringe = £1.98, 3500-unit(0.35-mL) syringe = £2.77, 4500-unit (0.45-mL)syringe = £3.56, 20 000-unit (2-mL) vial = £10.56Injection, tinzaparin sodium 20 000 units/mL, netprice 0.5-mL (10 000-unit) syringe = £8.46, 0.7-mL(14 000-unit) syringe = £11.85, 0.9-mL (18 000-unit)syringe = £15.23, 2-mL (40 000-unit) vial = £34.20Excipients include benzyl alcohol (in vials) (avoid in neonates, seeExcipients, p. 2), sulphites (in 20 000 units/mL vial and syringe)HeparinoidsDanaparoid is a heparinoid that has a role in childrenwho develop heparin-induced thrombocytopenia, providingthey have no evidence of cross-reactivity.DANAPAROID SODIUMCautions recent bleeding or risk of bleeding; concomitantuse of drugs that increase risk of bleeding;antibodies to heparins (risk of antibody-inducedthrombocytopenia)Contra-indications haemophilia and other haemorrhagicdisorders, thrombocytopenia (unless patienthas heparin-induced thrombocytopenia), recentcerebral haemorrhage, severe hypertension, activepeptic ulcer (unless this is the reason for operation),diabetic retinopathy, acute bacterial endocarditis,spinal or epidural anaesthesia with treatment doses ofdanaparoidHepatic impairment caution in moderate impairment(increased risk of bleeding); avoid in severe impairmentunless the child has heparin-induced thrombocytopeniaand no alternative availableRenal impairment use with caution in moderateimpairment; increased risk of bleeding (monitor anti-Factor Xa activity); avoid in severe impairment unlesschild has heparin-induced thrombocytopenia and noalternative availablePregnancy manufacturer advises avoid—limitedinformation available but not known to be harmfulBreast-feeding amount probably too small to beharmful but manufacturer advises avoidSide-effects haemorrhage; hypersensitivity reactions(including rash)Licensed use not licensed for use in childrenIndication and doseThromboembolic disease in children with historyof heparin-induced thrombocytopenia. By intravenous administrationNeonate initially 30 units/kg by intravenousinjection then by continuous intravenous infusion1.2–2 units/kg/hour adjusted according to coagulationactivity2 Cardiovascular system