NAME OF DRUG
danaparoid sodium

CLASSIFICATION

Anticoagulant, Low Molecular Weight Heparinoid

ALTERNATE NAME

ORGARAN 

INDICATIONS

• instant anticoagulant to be used in patients who develop heparin-induced thrombocytopenia (HIT)
• DVT prophylaxis in patients with proven HIT

 RECONSTITUTION AND STABILITY

• store at room temperature; protect from light
• available as 750 units/0.6mL

 COMPATIBILITY

• compatible with D5W, NS
• stable in infusion solutions for 24 hours at room temperature

 ROUTES OF ADMINISTRATION

• SC
• IV direct - undiluted over 10-20 seconds
• IV intermittent - in 50-100mL IV solution infused over 15-30 minutes
• IV infusion - dilute 2250 units (3 ampoules) in 250mL D5W or NS (= 9 units/mL)
• if volume restricted, can dilute to 18-27units/mL (6 ampoules - 4500 units/250mL or 9 ampoules - 6750 units/250mL, respectively)

 VH & HSC ADMINISTRATION POLICY

RESTRICTED TO HEMATOLOGY

E- Direct IV route can be administered by nurses on general nursing units provided a venous access has been established, and according to policies and recommendations stated in this manual.

H - The IV infusion administration rate MUST be controlled by an automated infusion control device.

DOSAGE

Therapeutic Anticoagulation

IV:

Loading Dose:

• < 60 kg       1500 units (2 ampoules) IV
• 60-75 kg     2250 units (3 ampoules) IV
• 75-90 kg     3000 units (4 ampoules) IV
• > 90 kg       3750 units (5 ampoules) IV

Maintenance Dose: 

• Add 2250 units (3 ampoules) to 250mL D5W or NS and infuse IV at 400 units/hr (=44mL/hr) x 4 hours, then 300 units/hr (=33mL/hr) x 4 hours, then 200 units/hr (=22mL/hr) thereafter

If infusion stopped 

• < 12 hours, restart at same rate
• 12-24 hours, restart at 300-400 u/hr x 4 hrs, then decrease to 200 u/hr
• > 24 hours, give loading dose then restart at 300 or 400 u/hr x 4 hrs, then decrease to 200 u/hr

SC:

• < 55 kg:      1500 units SC q12h

•  55-90 kg:    2000 units SC q12h

•  > 90 kg:      1750 units SC q8h

DVT Prophylaxis

• < 90kg: 750 units SC q12h
• > 90kg: 750 units SC q8h or 1250 units SC q12h

Prevention of clotting in extracorporeal hemodialysis circuit

• 750 units IV predialysis; adjust upward by 750 units qrun until adequate patency or maximum dose of 3750 units reaches (see Patient Care Guidelines)
• Monitor factor anti-Xa levels prior to fourth dose, 1 week after a dosage increase or if clinical evidence of bleeding (goal anti-factor Xa levels <0.35 units/mL)

Maintenance of intradialytic central venous catheter (CVC) Patency

• dilute 375 units (0.3 mL) with normal saline to volume of each CVC lumen.

 POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION

• overdosage - hemorrhage (Treatment - stop infusion, fresh frozen plasma may be indicated)
• pain, tingling at site of SC injection
• transient rash (incidence 0.5%), particularly at injection site

 IMPORTANT IMPLICATIONS

• avoid intramuscular (IM) injections
• avoid non-steroidal anti-inflammatory drugs (NSAIDS), if possible
• side effects include bleeding complications, thrombocytopenia (rare)
• hemoglobin and platelets should be monitored at baseline and at least on alternate days during therapy (patients being treated for HIT should have daily platelet counts while on danaparoid)
• cross-reactivity of danaparoid with heparin-induced antibodies is less than 10% (range 0-20%); if after 48 hours, following cessation of heparin and the initiation of danaparoid the platelets do not increase, the possibility of cross-reactivity should be considered and therapy switched to ancrod
• danaparoid should not modify global clotting tests (ie. aPTT, INR, thrombin time)
• contraindicated in patients allergic to sulfites
• contraindicated in patients with active bleeding, blood dyscrasias, subacute bacterial endocarditis, recent neruosurgical procedure, or active peptic ulcer disease
• the elimination half-life based on anti-Xa activity ranges from 17-28 hrs (mean 25 hrs)
• danaparoid is primarily eliminated via the kidneys - modest maintenance dose reductions are recommended in patients with severely impaired renal function (creatinine clearance < 20mL/minute)
• use with caution in patients with severe liver dysfunction
• protamine is not an antidote to danaparoid-associated bleeding complications

Rev. Nov 2005