2.8.1 Parenteral anticoagulants

Parenteral anticoagulants are for specialist initiation in secondary care only. See NICE 144 Venous Thromboembolic diseases (June 2012 and IPNSM shared care guideline for further information.


  • Heparin use in the elderly – caution is required in the frail/very elderly, in whom daily doses of 20,000 units may be sufficient for full heparinisation.
  • There is an increased risk of bleeding when enoxaparin is administered to patients with low body weight. Refer to the BNF or the Shared Care Guideline for dosage adjustments required.
  • There may be an increased risk of bleeding in patients with renal impairment – refer to BNF or SmPC for further information.