Fragmin Disease Interactions

Anticoagulants should be given with extreme caution to patients with hemophilia or other congenital or acquired bleeding tendencies. The risk of hemorrhage may be increased in these patients.

Switch to professional interaction data

Anticoagulants should be given with extreme caution to patients at increased risk for hemorrhage, including patients who have severe liver disease with impaired hemostasis.

Switch to professional interaction data

Anticoagulants are contraindicated in patients with active major bleeding or those patients at risk for hemorrhage. Hemorrhage due to heparin derivatives may be treated with protamine sulfate 1%. However, protamine sulfate may not completely neutralize the anti- Factor Xa activity.

Switch to professional interaction data

The use of anticoagulants may increase the risk of bleeding in patients with hypertensive or diabetic retinopathy. Therapy with anticoagulants should be administered with extreme caution in such patients.

Switch to professional interaction data

Anticoagulants should be given with extreme caution to patients with subacute bacterial endocarditis. The risk of hemorrhage may be increased in these patients.

Switch to professional interaction data

The use of heparin is contraindicated in patients with uncontrollable active bleeding, except when the bleeding is due to disseminated intravascular coagulation. Hemorrhage can occur at virtually any site in patients receiving heparin. An unexplained drop in hematocrit or blood pressure, or any other unexplained symptom, should lead to serious consideration of a hemorrhagic event. Therapy with heparin should be used with extreme caution in patients with known bleeding disorders or disease states that may predispose to hemorrhage during heparin administration, including hemophilia, thrombocytopenia, certain vascular purpuras, ulcerative gastrointestinal lesions, diverticulitis, ulcerative colitis, severe liver disease, subacute bacterial endocarditis, severe hypertension, myeloproliferative disorders, and threatened abortion. Blood coagulation tests (e.g., whole blood clotting time, activated partial thromboplastin time) should be performed at appropriate intervals during full-dose heparin administration. In addition, periodic platelet counts, hematocrits, and tests for occult blood in stool are recommended during the entire course of heparin therapy. There is usually no need to monitor coagulation parameters in patients receiving low-dose heparin, except in patients undergoing major surgery. For low molecular weight heparin (LMWH), coagulation tests such as prothrombin time (PT) and aPTT are relatively insensitive measures of LMWH activity and not suitable for routine monitoring. Anti-Factor Xa may be used to monitor the anticoagulant effect of LMWH in patients with significant renal impairment, abnormal coagulation parameters, or bleeding during therapy.

Switch to professional interaction data

Heparin should be used with extreme caution in patients with uncontrolled or severe hypertension as these conditions may predispose the patient to hemorrhage during heparin administration. Blood coagulation tests (e.g., whole blood clotting time, activated partial thromboplastin time) should be performed at appropriate intervals during full-dose heparin administration. In addition, periodic platelet counts, hematocrits, and tests for occult blood in stool are recommended during the entire course of heparin therapy. Clinical monitoring of blood pressure is recommended.

Switch to professional interaction data

Systemic exposure and the risk of bleeding may be increased when heparin is used in the presence of severe renal impairment. Therapy with heparin should be administered cautiously in patients with significantly impaired renal function. A reduction in dosage may be necessary.

Switch to professional interaction data

The use of heparin is contraindicated in patients with severe thrombocytopenia. Acute thrombocytopenia can occur in patients receiving heparin, with a reported incidence of up to 30%. Platelet counts should be obtained before and periodically during heparin administration, including regular and repeated use of heparin flush solutions if given for longer than 5 days. Mild thrombocytopenia with counts above 100,000/mm3 may remain stable or reverse despite continued heparin administration. However, thrombocytopenia of any degree should be closely monitored. Therapy should be discontinued if the count falls below 100,000/mm3 or if recurrent thrombosis develops, and an alternative, nonheparin anticoagulant (e.g., argatroban, bivalirudin, lepirudin) administered if necessary. Heparin-induced thrombocytopenia (HIT) is a serious antibody-mediated reaction resulting from irreversible aggregation of platelets. HIT may progress to the development of venous and arterial thromboses, a condition referred to as heparin-induced thrombocytopenia and thrombosis (HITT). Thrombotic events may also be the initial presentation for HITT, and may include deep vein thrombosis, pulmonary embolism, cerebral vein thrombosis, limb ischemia, stroke, myocardial infarction, mesenteric thrombosis, renal artery thrombosis, skin necrosis, gangrene of the extremities that may lead to amputation, and possibly death. Both HIT and HITT can occur up to several weeks after the discontinuation of heparin therapy. Patients presenting with thrombocytopenia or thrombosis after discontinuation of heparin should be evaluated for HIT and HITT. Following an episode, any future use of heparin should be avoided, and use of low-molecular weight heparin should consider the potential for cross-reactivity with the HIT antibody and approached with extreme caution, if not otherwise contraindicated.

Switch to professional interaction data

Some preparations (i.e., multiple-dose vials) of low molecular weight heparin (LMWH) contain benzyl alcohol as a preservative. Benzyl alcohol in bacteriostatic saline intravascular flush and endotracheal tube lavage solutions has been associated with fatalities and severe respiratory and metabolic complications in low-birthweight premature infants. Symptoms include a striking onset of gasping respiration, hypotension, bradycardia, and cardiovascular collapse. The manufacturers recommend that use of these products be avoided in all neonates whenever possible. Nevertheless, many experts feel that, in the absence of benzyl alcohol-free equivalents, the amount of the preservative present in these formulations should not necessarily preclude their use if they are clearly indicated. The American Academy of Pediatrics considers benzyl alcohol in low doses (such as when used as a preservative in some medications) to be safe for newborns. LMWHs are not approved for use in pediatric patients.

Switch to professional interaction data

Parenteral medications formulated in multidose vials often contain benzyl alcohol as a preservative. Their use is considered by drug manufacturers to be contraindicated in neonates, particularly premature infants and infants of low birth weight. When used in bacteriostatic saline intravascular flush and endotracheal tube lavage solutions, benzyl alcohol has been associated with fatalities and severe respiratory and metabolic complications in low-birth-weight premature infants. Thus, single-dose formulations should always be used in infants whenever possible. However, many experts feel that, in the absence of benzyl alcohol-free equivalents, the amount of the preservative present in these formulations should not necessarily preclude their use if they are clearly indicated. The American Academy of Pediatrics considers benzyl alcohol in low doses (such as when used as a preservative in some medications) to be safe for newborns. However, the administration of high dosages of these medications must take into account the total amount of benzyl alcohol administered. The level at which toxicity may occur is unknown.

Switch to professional interaction data

Anticoagulants should be used with extreme caution in patients at increased risk for hemorrhage, including those patients with severe hypertension.

Switch to professional interaction data

Anticoagulants should be given with extreme caution to patients with severe kidney dysfunction. Altered coagulation may increase the risk of bleeding in these patients. If an anticoagulant is administered, these patients should be monitored closely for signs of bleeding.

Switch to professional interaction data