The use of<unk> s should be avoided in patients with known allergies to<unk> s,<unk> , sulfites or benzyl alcohol, in patients with active major bleeding, or patients with a history of<unk> -induced<unk>  blood platelet count (also known as<unk> -induced thrombocytopenia or HIT). High treatment doses are contraindicated in acute bleedings such as cerebral or gastrointestinal haemorrhage.<unk> s are more dependent on renal function for their excretion than unfractionated<unk>  so their biological half-life may be prolonged in patients with kidney failure and therefore their use in the setting of creatinine clearance rate (CrCl) <30 mL/min may need to be avoided. Apart from using unfractionated<unk>  instead, it may be possible to reduce the dose and/or monitor the anti-Xa activity to guide treatment. The most common side-effects include bleeding, which could be severe or even fatal, allergic reactions, injection site reactions, and increases in liver enzyme tests, usually without symptoms. The use of<unk>  and<unk> s can sometimes be complicated by a decrease in platelet count, a complication known as<unk>  Induced Thrombocytopenia.13 Two forms have been described: a clinically benign, non-immune and reversible form (Type I) and a rare, more serious immune-mediated form or Type II. HIT Type II is caused by the formation of auto antibodies that recognize complexes between<unk>  and platelet factor 4 (PF4) and is therefore associated with a substantial risk of thrombotic complications. The incidence is difficult to estimate but may reach up to 5% of patients treated with UFH or about 1% with<unk> . Antidote In clinical situations in which the antithrombotic effect of<unk> s needs to be neutralized, protamine is used to neutralize<unk>  by binding to it. Studies in animals and in vitro studies have demonstrated that protamine neutralizes the antithrombin activity of<unk> s, normalizing the aPTT and thrombin time. However, protamine appears to only partially neutralize the anti-factor Xa activity of<unk> . Because the<unk><unk>  of<unk>  impacts its interaction with protamine, it is likely that the lack of complete neutralization of anti-factor Xa is due to a reduced protamine binding to the<unk> s moieties in the preparation. Protamine is a medicine that requires a high level of caution when used. Precautions<unk>  trials usually excluded individuals with unpredictable pharmacokinetics, and as a result patients with risks such as the severely obese or in advanced stages of kidney failure show decreased benefits due to fractionated<unk> 's increased half-life.<unk> s should be used with extreme caution in patients undergoing any procedure involving spinal anaesthesia/puncture, in conditions with increased risk of bleeding or in patients with a history of<unk> -induced thrombocytopenia.
Low-molecular-weight heparin
Fibrinolysis
Enoxaparin sodium
Thrombectomy
Palladin
Heparin
Tissue plasminogen activator
Tinzaparin sodium