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Other Considerations

  • Avoid aspirin, NSAIDs and other antiplatelet drugs unless required for specific disease management or clinical situation.

  • Consider alternative analgesics such as acetaminophen or choline magnesium salicylate (Trilisate®), as clinically appropriate, if analgesia is required.

  • Avoid IM injections and arterial punctures. Hold LMW heparin doses for 24 hours prior to immunizations or invasive procedures such as lumbar puncture and surgery unless the clinical situation requires an emergent intervention. Restart 12 hours after the procedure, surgery or immunization.

  • Measure platelet counts weekly until stable on LMW heparin. If platelet count decreases below 150,000/microL or drops by ≥ 50% determine if the decrease in platelet count is related to the underlying disorder or is potentially due to LMW heparin therapy. If likely due to LMW heparin, discontinue LMW heparin; initiate an alternative therapy and consult Hematology.

  • The optimal sample for LMW heparin levels is a fresh venipuncture site.

    • Alternate sites may be considered but present limitations with interpretation of the LMW heparinlevels.

    • Capillary samples are not appropriate.

    • Ensure that the sample is not contaminated by heparin (e.g. from an arterial line).

  • Mobilization should be encouraged as tolerated.

References:

David, M., et al. Heparin and LMWH in Children. Thrombosis Interest Group of Canada. January 2007. http://www.tigc.org/eguidelines/heparinchild07.htm. Accessed 11/15/08.

Lexi-Drugs Online/Pediatric Lexi-Drugs Online, Enoxaparin, http://online.lexi.com/crlsql/servlet/crlonline, Copyright © 1978-2008 Lexi-Comp, Inc, Hudson, OH 44236

Monagle P, Chan AKC, Goldenberg NA, Ichord RN, Journeycake JM, Nowak-Gottl U, Vesely SK. Antithrombotic therapy in neonates and children: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012; 141: e737S –e801S.

Roach ES. Golomb MR. Adams R. Biller J. Daniels S. Deveber G. Ferriero D. Jones BV. Kirkham FJ. Scott RM. Smith ER. American Heart Association Stroke Council. Council on Cardiovascular Disease in the Young. Management of stroke in infants and children: a scientific statement from a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young. [Journal Article] Stroke. 39(9):2644-91, 2008 Sep.

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.