Concerns were expressed at the increased volume of prescribing of low molecular weight heparins (LMWH) in primary care in Wales, and the lack of information or guidance to support prescribers.  In July 2009 therefore, prescribing data from sample of practices across Wales was reviewed.

Following a consultation, the following recommendations have been made, which are intended to establish the scenarios where provision of service can safely be undertaken in the community whilst simultaneously ensuring timely access to specialist care when needed: 

• LMWH treatment for four weeks or less should be prescribed and monitored by the initiating physician (any indication).
• Where there is a need to monitor LMWH treatment by measuring the anti-Xa level, patients should be prescribed and followed up regularly by specialist services.
• Treatment doses of LMWH prescribed for venous thromboembolism (VTE) in cancer patients are suitable for shared care for up to six months of treatment.  Shared care should be agreed in writing with an invitation to participate by consultant and response from the General Practitioner.
• Treatment doses of LMWH for VTE in pregnancy should be ‘hospital only’ prescribing.
• Prophylactic doses of LMWH in pregnancy for medical conditions (excluding the indication of obesity) should normally be prescribed by Secondary Care.  Mechanisms need to be agreed locally to support adequate supply between appointments (30-42 days). Further discussions are needed regarding the prescribing of prophylactic doses for obese patients.

Please see the link below for further details.