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Guidelines to manage heparin shortage

by Dr Linda Calabresi

Guidelines have been released to help manage patients needing anti-coagulation if there are shortages of heparin-based products.

The recent TGA recall of five batches of enoxaparin (Clexane) found to contain a contaminant, raised the prospect of a shortage of heparin-based products in Australia.

This possibility prompted the development of the guidelines  to prioritise the use of the available supplies of enoxaparin based on clinical need and provide advice as to alternatives where there is no compromise of the quality of care.

The Consensus Guidelines for Australian Clinicians for the use of anti-coagulants during heparin based product shortages set out a staged approach according to the availability of the different products.

At present, while supplies remain available, patients currently taking enoxaparin for a DVT, for example, can remain on the drug. However if supplies become difficult to obtain alternatives such as the low molecular weight heparin, Fragmin, or unfractionated heparin administered subcutaneously, or an oral anticoagulant such as warfarin might need to be considered.


19 May 2008
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Latest Comments

  • Enoxaparin (Clexane) is the safest, most effective form of heparin available. In the event of unexpected short-fall in supplies, the TGA should not be recommending second-rate forms of heparin or, worse still, warfarin during the active phase of thrombosis or for hip surgery thromboprophylaxis.

    Fondaparinux is a synthetic heparinoid which is proven to be safe and effective. It is superior to enoxaparin for thromboprophylaxis in association with hip surgery and hip fracture. It is superior to dalteparin for thromboprophylaxis in association with abdominal surgery. It is equivalent to Clexane in treatment of DVT and unfractionated heparin in treatment of pulmonary embolism (MIMS Full Prescribing Information).

    Why was fondaparinux not given a big push in these guidelines? Simple: it is a lot more expensive than the others. But as it is synthetic, so the factories can easily up-scale their production rates and save us a repeat of this regrettable incident. This is an opportunity for the Australian government to negotiate affordable, long-term supplies of a good anticoagulant. Let’s try, shall we?

    Steve Flecknoe-Brown

    Haematologist

    Posted by Steve Flecknoe-Brown 20/05/2008 8:47:54 AM

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