Haematology - LUHFT wide

 

Why do I need to take low molecular weight heparin (LMWH)?

You have been prescribed LMWH because you have developed a blood clot or are at risk of developing one.

What are the benefits of treatment with low molecular weight heparin?

The benefits of having this drug are:

  • It can be given as an outpatient.
  • It’s a subcutaneous injection (This is an injection given just under the skin)
  • It is absorbed into the bloodstream through the tissues under your skin and is

considered the safest way of giving an anticoagulant for your diagnosis.

How does LMWH work?

LMWH is an anticoagulant which comes in the form of a prefilled injection and is given

under the skin. It increases the time your blood takes to clot. This will reduce the risk of

developing or extending a blood clot.

LMWH starts to work within two hours of being injected.

LMWH are usually made from pork products (porcine), however there is an alternative non porcine based preparation. Please discuss any spiritual /religious and lifestyle beliefs with your medical professional.  

How do I store LMWH?

You should keep the injections at room temperature but avoid storing them in direct

sunlight or near a radiator.

What are the risks and side effects of LMWH treatment?

The main risk of taking any anticoagulant is bleeding as mentioned below.

  • Bleeding - as your blood will take longer to clot than normal you will bleed more

easily.

  • Oozing - occasionally the injection site will ooze blood or watery fluid. Apply

pressure with a clean tissue until it stops.

  • Bruising - you may experience bruising at the injection site. If you are also taking

Aspirin, then any bruising may be more noticeable.

  • Allergy – rarely, patients experience an allergic reaction at the injection site. This is

usually, redness or itching.

  • Osteoporosis - patients on prolonged treatment with other forms of heparin have

experienced a reduction in their bone density which can lead to osteoporosis.

  • Rarely, a reduction in your platelet count may occur within five days of starting

treatment. Your blood count will be tested to check for this.

Are there any alternative treatments available?

Anticoagulants can be given intravenously (into a vein), subcutaneously (under the skin)

and by mouth.

At present the subcutaneous injections are the safest form of anticoagulant for your

diagnosis.

What will happen if I decide not to have treatment?

If you decide not to take the treatment, this could lead to you developing a blood clot or your current clot extending. This could be potentially life threatening.

How do I administer LMWH?

Step One

Wash your hands carefully with soap and water and ensure the injection site is clean.

Step Two

Position yourself so you are comfortable and in an upright position.

Step Three

Choose an area of fat on either your thigh or stomach (alternate sites on your stomach)

always avoiding the belly button area.

Step Four

Remove the needle cap by pulling it straight off the syringe and discard it in a yellow sharps bin which you should have been provided with.

Step Five

Hold the syringe like a pencil in your writing hand

Step Six

With your other hand ‘pinch an inch’ of the chosen area of skin so that you have made a fold in the skin.

Insert the needle straight into the fold of skin at a 90-degree angle as below

Step Seven

Press the plunger down on the syringe with your thumb until the syringe is empty.

Step Eight

Pull the needle straight out at the same angle it was entered and release the skin fold.

Step Nine

At this point make sure the safety cap is activated and always hold the syringe down and away from yourself. Depending on the brand of LMWH the safety cap will activate in a different way (your healthcare professional will show you this).

Step Ten

Place the syringe in the yellow sharps box allocated to you. Do not overfill the sharps box.

Sharps Disposal

When your sharps box is full, and you need to dispose of your sharps box you need to reorder a new sharps bin via your GP practice and arrange disposal of your full sharps box by one of the following methods depending on where you live:

Any patients living outside these areas please enquire at your GP practice directly.

Note: Please remember to always re-order a new sharps bin via your GP practice

How is LMWH monitored?

We will monitor a clotting factor in your blood called Anti Xa. The most accurate way to do this is to take a blood sample four hours after your injection has been administered.

This will determine if this is the right dose for you.

If we need to adjust your dose of LMWH we will inform you via telephone and provide you with a prescription.

We will monitor your Anti Xa level weekly until in range. Once you are in a suitable range you will only need to be monitored eight to twelve weekly depending on the individual patient.

You should seek urgent medical attention if you notice any of the following symptoms of bleeding:

  • Blood in your bowel movements or black/tarry bowel movements
  • Red/Rose coloured urine.
  • Menstrual bleeding that is much heavier than usual.
  • Coughing up or vomiting blood.
  • Any bleeding that won’t stop.
  • Physical injury such as head injury, broken bone, car accident.
  • If an injection site becomes red, painful, warm to touch, or oozes, these can be

signs of infection and you should contact your doctor or specialist nursing team.

  • New rashes.
  • Unexplained bruising.

 

What to do if I ever miss an injection

If you remember the same day, take the injection immediately and then take your usual

dose the next day.

If you remember the next day or later: take your usual dose for that day only

Never take double the dose in the 24-hour period.

If you are unsure on your dosage, then always contact your specialist nurse.

What to do if I ever overdose on injections or have bleeding issues

Contact your specialist nursing team between the hours of 9-5 Monday to Friday. Outside of these hours you should contact NHS 111 where you will be directed to the most appropriate service.

 

Feedback

Your feedback is important to us and helps us influence care in the future.

Following your discharge from hospital or attendance at your outpatient appointment you will receive a text asking if you would recommend our service to others. Please take the time to text back, you will not be charged for the text and can opt out at any point. Your co-operation is greatly appreciated.

Further information

Haematology Liverpool Tel: 0151 706 3397

Text phone number:  18001 0151 706 3397

 

Author: Haematology Liverpool

Review date: April 2029

PI 2087 V3