Separate low molecular weight fractions are now commercially available and has been shown to be effective in a variety of thrombotic states including DVT and pulmonary embolism. Their use in arterial thromboembolic disease is being explored. They are administered subcutaneously, have a superior safety profile to unfractionated heparin and a much more predictable dose-response curve. If desired, activity can be measured with anti Factor Xa levels drawn 4 hrs post dose to achieve a level of 0.4-1.1. Fragmin has no effect on the PTT and it is not useful to follow this value during treatment.
Alternative anticoagulants exist.
Activity can be measured with anti Factor Xa levels drawn 6randomly during iv infusions or at 6 hrs post sq dose to achieve a level of 0.5-0.8. Orgaran has no effect on the PTT and it is not useful to follow this value during treatment. Bleeding due to heparin administration can be controlled with Protamine. The dose is based on the amount of heparin that has been received. Give 1 mg Protamine for each mg of Fragmin at the last Fragmin injection.