Low-molecular-weight heparin (LMWH) is a type of medicine known as an anticoagulant. These medicines are used to prevent and treat clot formation in blood vessels, also called thrombosis.
What are the different LMWHs used in children?
enoxaparin (Lovenox®)
dalteparin (Fragmin®)
tinzaparin (Innohep®)
How does LMWH work?
Two important components for forming a clot in the blood are factor Xa and thrombin. LMWH acts by stopping the activity of factor Xa and thrombin and increasing the activity of other proteins in the blood to prevent the formation of clots.
How much LMWH is needed?
The amount of LMWH given is based on the child’s medical problem requiring a LMWH and his weight. LMWH doses are based on different measurements.
enoxaparin (Lovenox®) is based on milligrams (mg)
dalteparin (Fragmin®) is based on units
tinzaparin (Innohep®) is based on units
Normally the dose is given one to two times a day. The dose may be adjusted based on lab tests.
How is LMWH given?
LMWH is given by a subcutaneous injection. A subcutaneous injection is similar to an insulin injection, and is administered into the tissue just below the skin. These injections can be given in the legs, arms or abdomen. Click here to learn how to administer shots in the abdomen. Sometimes a subcutaneous catheter may be used to help with ease of administering the medication. If a subcutaneous catheter is used, you should be taught how to use the subcutaneous catheter for administration of the medication.
What tests are needed when on LMWH?
A laboratory test may be done to monitor for the effects of the LMWH. An anti-factor Xa level in the blood (also called a LMWH level or heparin assay) will be checked after starting the medicine. Then depending on the child’s age and medical problem, the anti-factor Xa level may need to be rechecked as often as once to twice a month.
Special Instructions while receiving LMWH:
Tell your child's dentist, doctor, or surgeon at the beginning of each visit that your child is taking a LMWH
Do not give your child any other medication without first talking to your doctor or pharmacist (for example, avoid products containing ibuprofen or aspirin while on LMWH; avoid warfarin)
Do not use after the expiration date on the bottle or package
Keep this medication out of the reach of children
Monitor your child for excessive bleeding
What are the side-effects of LMWH?
Bruising
Bleeding
Irritation, burning, or pain at the injection site
When to call the doctor?
If any of the following are experienced, contact your physician immediately:
Unusual bruising, prolonged bleeding, or tender swellings without obvious cause
Nose bleeds
Heavy bleeding from the gums
Black, tarry, or bloody stools
Urine that is bloody, dark brown, or cloudy
Vomit that looks like coffee grounds or containing blood
Severe or persistent dizziness, tiredness, or weakness
Suffering a blow to the head, even without losing consciousness
Sever and prolonged headaches
Severe allergic reactions (rash, hives, itching, difficulty breathing, tightness in the chest, swelling of the face)
Where can I get LMWH?
For most children, LMWH may be obtained at your local pharmacy with a prescription. For young children, giving LMWH at home may be a challenge because of the unique dose needed. The amount is smaller than the doses available from the drug company. Below are methods that can be used to help give LMWH’s safely to young children at home.
One way is to use a multiple-dose vial of the LMWH, if available. For example, enoxaparin comes as 300 mg/3 mL vial and the correct dose may be drawn up into an insulin syringe. This product is normally stable for 30 days after opening and may be ordered by your local pharmacy.
Another way is to dilute the LMWH to a desirable concentration with sterile water for injection. For example, if an enoxaparin dose of less than 10mg is needed, a dilution can be done (to make a concentration of 10 mg/ml or 20mg/mL). Then doses can be drawn up into 1ml syringes. This product is stable for a limited time and normally requires the help of a special pharmacy.
How to Administer Subcutaneous Injections
The following list of instructions will help you to properly administer shots to your child in the stomach:
Have your child lie down.
Wash your hands and the area of skin where you will give the shot.
Look at the syringe to be sure the drug is clear and colorless.
Take the cap off the needle. Do not push any air or drug out of the syringe before giving the shot.
Pinch a fold of skin between the fingers and thumb. Push the entire needle into the skin of the stomach area and then press down on the syringe plunger to inject the drug. Hold onto the skin the entire time you give the shot. Do not rub the site after you give the shot to minimize bruising.
Throw away syringe and needle in proper container (sharps container).
Use a different area of the stomach each time you give the shot.
You can also find more detailed step-by-step information on how to prepare and give subcutaneous shots in a related KidsMeds article.
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