Skip to main content

Adverse Effects

  • Bleeding:

    • Most common adverse effect, discontinue LMW heparin

    • Refer to LMW heparin antidote section for management

  • Osteoporosis:

    • Uncommon

    • Occurs with prolonged LMW heparin

    • Monitor bone density if LMW heparin therapy exceeds 3 months

    • For patients receiving LMW heparin therapy > 3 months, consider bone densitometry studies on day 1 and approximately every 12 months to assess for possible osteoporosis

  • Thrombocytopenia due to heparin-induced thrombocytopenia (HIT):

    • Risk in children is low

    • May be asymptomatic

    • May be associated with life threatening or fatal arterial or venous thrombosis

    • The risk for (HIT) is greater after 5 days of LMW heparin

    • Suspect HIT if platelet count decreases by 50% or decreases below 150,000/microL

    • Consult Hematology if HIT suspected


David, M., et al. Heparin and LMWH in Children. Thrombosis Interest Group of Canada. January 2007. Accessed 11/15/08.

Lexi-Drugs Online/Pediatric Lexi-Drugs Online, Enoxaparin,, 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 pathways 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 a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.