danaparoid sodium

Therapeutic Classification: anticoagulants

Pharmacologic Classification: low molecular weight heparins

REMS

Prevention of thromboembolic phenomena including deep vein thrombosis and pulmonary emboli after surgical procedures known to increase the risk of such complications (knee/hip replacement, abdominal surgery).
Management of non-hemorrhagic stroke.
Treatment/prevention of thromboembolic phenomena in patients with a history of heparin-induced thrombocytopenia (HIT)

Potentiates the inhibitory effect of antithrombin on factor Xa and thrombin.
Danaparoid sodium is a heparinoid.

Therapeutic effects:

Prevention of thrombus formation.

Absorption: 100% absorbed after SUBQ administration; IV administration results in complete bioavailability.

Distribution: Unknown.

Metabolism/Excretion: Excreted mostly by the kidneys.

Half-Life: 25 hr.

(anticoagulant effect)

ROUTE	ONSET	PEAK	DURATION
SUBQ	unknown	2–5 hr	12 hr

Contraindicated in:

Hypersensitivity to danaparoid sodium, pork products, or sulfites;
Uncontrolled bleeding;
Imminent/threatened abortion;
Lactation: Avoid breastfeeding.

Use Cautiously in:

Severe hepatic or renal impairment (dosage ↓ may be necessary in severe renal impairment);
Retinopathy (hypertensive or diabetic);
Untreated hypertension;
Recent history of ulcer disease;
Spinal/epidural anesthesia;
History of congenital or acquired bleeding disorder;
Malignancy;
History of thrombocytopenia related to heparin (HIT), has been used successfully;
OB: Safe use in pregnancy has not been established;
Geri: Dosage may be necessary in severe renal impairment;
Pedi: Safety not established.

Severe uncontrolled hypertension;
Bacterial endocarditis, bleeding disorders;
GI bleeding/ulceration/pathology;
Hemorrhagic stroke;
Recent CNS or ophthalmologic surgery;
Active GI bleeding/ulceration.

CNS: dizziness, headache, insomnia

CV: edema

GI: constipation, nausea, reversible increase in liver enzymes, vomiting

GU: urinary retention

Derm: ecchymoses, pruritus, rash, urticaria

Hemat: bleeding, anemia, thrombocytopenia

Local: erythema at injection site, hematoma, irritation, pain

Misc: fever

Drug-drug:

Risk of bleeding may be ↑ by concurrent use of other anticoagulants including warfarin or drugs that affect platelet function, including aspirin, NSAIDs, dipyridamole, some penicillins, clopidogrel, ticlopidine, and dextran.

Prophylaxis of DVT (non HIT patients)

HIT

SC (Adults ): 750 anti-factor Xa IU every 12 hr starting 1–4 hr preop and at least 2 hr postop for 7–10 days or until ambulatory (up to 14 days). Prophylaxis of DVT following Orthopedic, Major Abdominal Surgery, and Thoracic Surgery: 750 anti-factor Xa units, twice daily up to 14 days, initiate 1–4 hr preop.
IV SC (Adults ): Prophylaxis of Deep Vein Thrombosis in Non-hemorrhagic Stroke Patients: up to 1000 anti-Xa units IV, followed by 750 anti-Xa units subcutaneously, twice daily for 7–14 days.
IV SC (Adults ): DVT prophylaxis, current HIT, ≤90 kg: 750 anti-Xa units SC two or three times daily for 7–10 days (initial bolus of 1250 anti-Xa units IV may be used); DVT prophylaxis, current HIT, >90 kg: 1250 anti-Xa units SC two or three times daily for 7–10 days (initial bolus of 1250 anti-Xa units IV may be used); DVT prophylaxis, past (>3 mo) HIT, ≤90 kg: 750 anti-Xa units SC two or three times daily for 7–10 days; DVT prophylaxis, past (>3 mo) HIT, >90 kg: 750 anti-Xa units SC three times daily or 1250 anti-Xa units SC twice daily for 7–10 days; Established pulmonary embolism or DVT, thrombus <5 days, >90 kg: 3750 anti-Xa units IV bolus, then 400 anti-Xa units/hr for 4 hr, then 300 anti-Xa units/hr for 4 hr, then 150–200 anti-Xa units/hr for 5–7 days or 1750 anti-Xa units SC twice daily for 4–7 days; Established pulmonary embolism or DVT, thrombus <5 days, 55–90 kg: 2250–2500 anti-Xa units IV bolus, then 400 anti-Xa units/hr for 4 hr, then 300 anti-Xa units/hr for 4 hr, then 150–200 anti-Xa units/hr for 5–7 days or 2000 anti-Xa units SC twice daily for 4–7 days; Established pulmonary embolism or DVT, thrombus <5 days, <55 kg: 1250–1500 anti-Xa units IV bolus, then 400 anti-Xa units/hr for 4 hr, then 300 anti-Xa units/hr for 4 hr, then 150–200 anti-Xa units/hr for 5–7 days or 1500 anti-Xa units SC twice daily for 4–7 days; Established pulmonary embolism or DVT, thrombus ≥5 days, >90 kg: 1250 anti-Xa units IV bolus, then 750 anti-Xa units SC three times daily or 1250 anti-Xa units twice daily; Established pulmonary embolism or DVT, thrombus ≥5 days, ≤90 kg: 1250 anti-Xa units IV bolus, then 750 anti-Xa units SC 2–3 times daily; Surgical prophylaxis, nonvascular surgery, >90 kg: 750 anti-Xa units SC 1–4 hr before procedure, repeat ≥6 hr after procedure, then 1250 anti-Xa units SC twice daily for 7–10 days; Surgical prophylaxis, nonvascular surgery, ≤90 kg: 750 anti-Xa units SC 1–4 hr before procedure, repeat ≥6 hr after procedure, then 750 anti-Xa units SC twice daily for 7–10 days; Surgical prophylaxis, embolectomy, >90 kg: 2250–2500 anti-Xa units IV bolus before procedure, then 150–200 anti-Xa units/hr IV starting ≥6 hr after procedure for 5–7 days or 750 anti-Xa units 2–3 times daily or change to oral anticoagulants after several days; Surgical prophylaxis, embolectomy, 55–90 kg: 2250–2500 anti-Xa units IV bolus before procedure, then 1250 anti-Xa units SC twice daily starting ≥6 hr after procedure, then 750 anti-Xa units 2–3 times daily or change to oral anticoagulants after several days; Cardiac catheterization >90 kg: 3750 anti-Xa units IV bolus prior to procedure; Cardiac catheterization <90 kg: 2500 anti-Xa units IV bolus prior to procedure; Percutaneous transluminal coronary angioplasty: 2500 anti-Xa units IV prior to procedure, then 150–200 anti-Xa units/hr IV for 1–2 days after procedure, may be followed by 750 anti-Xa units SC for several days; Intra-aortic balloon pump catherization, >90 kg: 3750 anti-Xa units IV bolus before procedure, then 150–200 anti-Xa units/hr IV or a 2nd bolus of 1250 anti-Xa units IV or 750 anti-Xa units SC two or three times daily or 1250 anti-Xa units SC twice daily; Intra-aortic balloon pump catherization, <90 kg: 2500 anti-Xa units IV bolus before procedure, then 150–200 anti-Xa units/hr IV or a 2nd bolus of 1250 anti-Xa units IV or 750 anti-Xa units SC two or three times daily or 1250 anti-Xa units SC twice daily; Peripheral vascular bypass: 2250–2500 anti-Xa units IV bolus before procedure, then 150–200 anti-Xa units/hr IV started ≥6 hr after procedure for 5–7 days or 750 anti-Xa units SC two or three times daily or change to oral anticoagulants; Hemodialysis, every other day or less frequently: 3750 anti-Xa units IV bolus before first 2 hemodialysis, then 3000 anti-Xa units IV bolus (if plasma antifactory Xa level <300 U/L) or 2500 anti-Xa units IV (if plasma antifactory Xa levels 350–400); Hemodialysis, every other day or less frequently, <55kg: 2500 anti-Xa units IV bolus before first 2 hemodialysis, then 2000 anti-Xa units IV bolus (if plasma antifactory Xa level <300 U/L), or 1500 anti-Xa units IV (if plasma antifactory Xa levels 350–400); Hemodialysis, daily: 3750 anti-Xa units IV before first dialysis, then 2500 before second dialysis; Hemodialysis, daily, <55kg: 2500 anti-Xa units IV before first dialysis, then 2000 before second dialysis; Hemofiltration, 55–90kg: 2500 anti-Xa units IV bolus, then 600/h for 4h, then 400/h for 4/h, then 200–600/h to maintain plasma antifactory Xa levels of 500–1000 U/L; Hemofiltration, <55kg: 2000 anti-Xa units IV bolus, then 400/h for 4h, then 150–400/h to maintain plasma antifactory Xa levels of 500–1000 U/L.

Solution for injection (contains sulfites): 750 anti-factor Xa units/0.6 mL ampule

Assess for signs of bleeding and hemorrhage (bleeding gums; nosebleed; unusual bruising; black, tarry stools; hematuria; fall in hematocrit or BP; guaiac-positive stools); bleeding from surgical site. Notify health care professional if these occur.
- Assess for evidence of additional or increased thrombosis. Symptoms will depend on area of involvement. Monitor neurological status frequently for signs of neurological impairment. May require urgent treatment.
- Monitor patient for hypersensitivity reactions (chills, fever, urticaria).
- Monitor patients with epidural catheters frequently for signs and symptoms of neurologic impairment.
SC: Observe injection sites for hematomas, ecchymosis, or inflammation.

Lab Test Considerations:

Monitor CBC, and stools for occult blood periodically during therapy. Monitor platelet count every other day for first wk, twice weekly for next 2 wk, and weekly thereafter. If thrombocytopenia occurs, monitor closely. If hematocrit decreases unexpectedly, assess patient for potential bleeding sites.
- Special monitoring of clotting times (aPTT) is not necessary.
- May cause ↑ in AST, ALT, and alkaline phosphatase levels.

Toxicity and Overdose:

Danaparoid sodium is not reversed with protamine sulfate. If overdose occurs, discontinue danaparoid sodium. Transfusion with fresh frozen plasma and plasmapheresis has been used if bleeding is uncontrollable.

Cannot be used interchangeably (unit for unit) with unfractionated heparin or other low-molecular-weight heparins.
Conversion to oral anticoagulant therapy (unless it is contraindicated) should not be started until adequate antithrombotic control with parenteral danaparoid sodium has been achieved; conversion may take up to 5 days.
SC: Administer deep into SUBQ tissue. Alternate injection sites daily between the left and right anterolateral and left and right posterolateral abdominal wall. Inject entire length of needle at a 45° or 90° angle into a skin fold held between thumb and forefinger; hold skin fold throughout injection. Do not aspirate or massage. Rotate sites frequently. Do not administer IM because of danger of hematoma formation. Solution should be clear; do not inject solution containing particulate matter.
- If excessive bruising occurs, ice cube massage of site before injection may lessen bruising.

IV Administration:

SUBQ is preferred route. Diluent: If administered IV, give as a bolus. May dilute with 0.9% NaCl, D5/0.9% NaCl, Ringer's, LR, and mannitol. Stable for up to 48 hr at room temperature.
Y-Site Incompatibility: Administer separately; do not mix with other drugs.

Instruct patient in correct technique for self-injection, care and disposal of equipment.
Advise patient to report any symptoms of unusual bleeding or bruising, dizziness, itching, rash, fever, swelling, or difficulty breathing to health care professional immediately.
Instruct patient not to take aspirin, naproxen, or ibuprofen without consulting health care professional while on danaparoid sodium therapy.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Prevention of deep vein thrombosis and pulmonary emboli.

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

Canadian Brand Names ⬆