Canada-Approved Medicine
This monograph describes a medication approved for use in Canada by the Therapeutic Products Directorate, a division of Health Canada’s Health Products and Food Branch. The medication is not approved by the United States Food and Drug Administration; however, a similar formulation carrying a different generic or brand name might be available in the US.
Pronunciation:
da-nap-a-roid
Trade Name(s)
Ther. Class.
Pharm. Class.
low molecular weight heparins
Therapeutic Effect(s):
Prevention of thrombus formation.
Absorption: 100% absorbed after SUBQ administration; IV administration results in complete bioavailability.
Distribution: Unknown.
Metabolism and Excretion: Excreted mostly by the kidneys.
Half-life: 25 hr.
TIME/ACTION PROFILE (anticoagulant effect)
ROUTE | ONSET | PEAK | DURATION |
---|---|---|---|
SUBQ | unknown | 2–5 hr | 12 hr |
Contraindicated in:
Use Cautiously in:
Exercise Extreme Caution in:
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
* CAPITALS indicate life-threatening.
Underline indicate most frequent.
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)
SUBQ (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 SUBQ (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.
HIT
IV SUBQ (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
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.
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.
Prevention of deep vein thrombosis and pulmonary emboli.