Fluxum ® can not be administered intramuscularly.
Thrombocytopenia induced by heparin
It is known that Flyuksum® as heparin itself and other low molecular weight heparins can cause thrombocytopenia. Heparin-induced thrombocytopenia usually develop 4-10 days after the start of treatment, or earlier in repeated occasions. In 10-20% of patients with early mild occurs thrombocytopenia (platelet count> 100,000 / ul), which may regress or persist with continued treatment. As a result, formation of antibodies to the complex of heparin / platelet factor 4, in some cases, may develop a more severe form of immune, heparin-induced thrombocytopenia II type, followed by thrombus formation and thromboembolism in the cerebral arteries, lungs, and other lower limb. Often with fatal consequences.During the treatment with Fluxum, patients should be carefully monitored. For long-term treatment, the number of platelets should be determined before the beginning of Fluxum therapy and 2 times a week during the first month, and then monitoring of the platelet count may be more rare. With extreme caution, Fluxum® should be given to patients who have a history of thrombocytopenia caused by heparin or other low-molecular-weight heparin, the platelet count must be calculated every day. If thrombocytopenia occurs during treatment with heparin, an alternative treatment may be therapy with low molecular weight heparins. In this case, the number of platelets should be determined daily and, if thrombocytopenia persists, low-molecular-weight heparin should be discontinued as early as possible. If thrombocytopenia is less than 100,000 / mm3, with the onset and progression of thrombosis, Fluxum® should be discontinued and the patient transferred to another anticoagulant therapy. Switching to oral anticoagulant therapy in these cases is not recommended, since it is known about the progression of thrombosis.
If suspicion of heparin-induced thrombocytopenia, platelet aggregation assays in vitro do not have a large diagnostic value, it is necessary to consult specialists.
Spinal / epidural anesthesia
Conducting spinal or epidural anesthesia, spinal epidural analgesia or lumbar puncture against the background of preventive use of Fluxum, as well as other low molecular weight heparins, can be complicated by spinal or epidural hematoma with the development of persistent or irreversible paralysis. The risk of these complications increases with the use of epidural catheters, with the concomitant NSAIDs, antiplatelet drugs or anticoagulants, in trauma or repeated spinal punctures, the presence of initial hemostasis disorders or in elderly patients. If anesthesia / analgesia of this type is necessary, against the backdrop of the prophylactic use of Fluxum, the presence of these risk factors should be carefully checked before these interventions.
Usually, spinal catheters are installed no earlier than 8-12 hours after the last injection of a prophylactic dose of low molecular weight heparin.Do not administer Fluxum® 2 to 4 hours before and after catheter placement / removal. The injection should be delayed or canceled if the blood from the spinal canal is aspirated during spinal or epidural anesthesia. The catheter should be removed as late as possible (after 8-12 hours) of the last prophylactic administration of Fluxum.
Special attention should be paid to patients who received Fluxum® before or after epidural or spinal anesthesia, checking for neurologic symptoms such as back pain, sensory and motor disorders (numbness or weakness in the lower extremities), impaired bowel or bladder function. Patients should be informed of the need to seek immediate medical attention if these symptoms occur. If suspected epidural or spinal hematoma requires immediate diagnosis and treatment, including decompression of the spinal cord.