Drug reference

Danaparoid sodium

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 161, 162

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Prevention of deep-vein thrombosis in general or orthopaedic surgery ▶BY SUBCUTANEOUS INJECTION ▶Adult: 750 units twice daily for 7–10 days, initiate treatment before operation, with last pre-operative dose 1–4 hours before surgery Thromboembolic disease in patients with history of heparin-induced thrombocytopenia ▶INITIALLY BY INTRAVENOUS INJECTION ▶Adult (body-weight up to 55 kg): Initially 1250 units, then (by continuous intravenous infusion) 400 units/hour for 2 hours, then (by continuous intravenous infusion) 300 units/hour for 2 hours, then (by continuous intravenous infusion) 200 units/hour for 5 days ▶Adult (body-weight 55–89 kg): Initially 2500 units, then (by continuous intravenous infusion) 400 units/hour for 2 hours, then (by continuous intravenous infusion) 300 units/hour for 2 hours, then (by continuous intravenous infusion) 200 units/hour for continued → 5 days ▶Adult (body-weight 90 kg and above): Initially 3750 units, then (by continuous intravenous infusion) 400 units/hour for 2 hours, then (by continuous intravenous infusion) 300 units/hour for 2 hours, then Cardiovascular system (by continuous intravenous infusion) 200 units/hour for 5 days

PDF pages 161, 162

Contra Indications

Active peptic ulcer (unless this is the reason for operation). acute bacterial endocarditis. diabetic retinopathy. epidural anaesthesia (with treatment doses). haemophilia and other haemorrhagic disorders. recent cerebral haemorrhage. severe uncontrolled hypertension. spinal anaesthesia (with treatment doses). thrombocytopenia (unless patient has heparin-induced thrombocytopenia) Acute bacterial endocarditis. after major trauma. Avoid injections containing benzyl alcohol in neonates. epidural anaesthesia with treatment doses. haemophilia or other haemorrhagic disorders. peptic ulcer . recent cerebral haemorrhage. recent surgery to eye. recent surgery to nervous system. spinal anaesthesia with treatment doses. thrombocytopenia (including history of heparin-induced thrombocytopenia)

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Cautions

Antibodies to heparins (risk of antibody- induced thrombocytopenia). body-weight over 90 kg. recent bleeding. risk of bleeding Elderly. severe hypertension

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Allergy And Cross Sensitivity

Hypersensitivity to unfractionated or low molecular weight heparin.

PDF page 162

Safety

Interactions

→Appendix 1: danaparoid

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Side Effects

▶Common or very common Haemorrhage. heparin-induced thrombocytopenia. skin reactions. thrombocytopenia ▶Uncommon Post procedural haematoma ▶Rare or very rare Anastomotic haemorrhage ▶Common or very common Haemorrhage. heparin-induced thrombocytopenia. skin reactions. thrombocytopenia. thrombocytosis ▶Uncommon CNS haemorrhage ▶Rare or very rare Alopecia. hyperkalaemia. osteoporosis (following long term use). priapism ▶Frequency not known Hypoaldosteronism SIDE-EFFECTS, FURTHER INFORMATION Haemorrhage If haemorrhage occurs it is usually sufﬁcient to withdraw unfractionated or low molecular weight heparin, but if rapid reversal of the effects of the heparin is required, protamine sulfate is a speciﬁc antidote (but only partially reverses the effects of low molecular weight heparins). Heparin-induced thrombocytopenia Clinically important heparin-induced thrombocytopenia is immune- mediated and can be complicated by thrombosis. Signs of heparin-induced thrombocytopenia include a 30% reduction of platelet count, thrombosis, or skin allergy. If heparin-induced thrombocytopenia is strongly suspected or conﬁrmed, the heparin should be stopped and an alternative anticoagulant, such as danaparoid, should be given. Ensure platelet counts return to normal range in those who require warfarin. Hyperkalaemia Inhibition of aldosterone secretion by unfractionated or low molecular weight heparin can result in hyperkalaemia; patients with diabetes mellitus, chronic renal failure, acidosis, raised plasma potassium or those taking potassium-sparing drugs seem to be more susceptible. The risk appears to increase with duration of therapy.

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Pregnancy

Manufacturer advises avoid—limited information available but not known to be harmful.

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Breast Feeding

Amount probably too small to be harmful but manufacturer advises avoid.

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Hepatic Impairment

Manufacturer advises caution in moderate impairment with impaired haemostasis— increased risk of bleeding; avoid in severe hepatic failure unless patient has heparin-induced thrombocytopenia and no alternative available.

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Renal Impairment

Use with caution in moderate impairment. Avoid in severe impairment unless patient has heparin-induced thrombocytopenia and no alternative available. Monitoring Increased risk of bleeding in renal impairment, monitor anti-Factor Xa activity.

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Monitoring Requirements

Monitor anti factor Xa activity in patients with body-weight over 90 kg. ▶Heparin-induced thrombocytopenia Platelet counts should be measured just before treatment with unfractionated or low molecular weight heparin, and regular monitoring of platelet counts may be required if given for longer than 4 days. See the British Society for Haematology’s Guidelines on the diagnosis and management of heparin- induced thrombocytopenia: second edition. Br J Haematol 2012; 159: 528–540. ▶Hyperkalaemia Plasma-potassium concentration should be measured in patients at risk of hyperkalaemia before starting the heparin and monitored regularly thereafter, particularly if treatment is to be continued for longer than 7 days. eiiii F above

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Dose and formulations

Directions For Administration

For intravenous infusion, give continuously in Glucose 5% or Sodium chloride 0.9%.

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Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Solution for injection ▶Danaparoid sodium (Non-proprietary) Danaparoid sodium 1250 unit per 1 ml Danaparoid sodium 750units/0.6ml solution for injection ampoules | 10 ampoule P £599.99 | 10 ampoule P £599.99 (Hospital only) ANTITHROMBOTIC DRUGS › HEPARINS Heparins f

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Dose text by age group

Adult

750 units twice daily for 7–10 days, initiate

First-line fragment. Read the complete Indications and Dose section above.

PDF page 161

Adult (body-weight up to 55 kg)

Initially 1250 units, then

First-line fragment. Read the complete Indications and Dose section above.

PDF page 161

Adult (body-weight 55–89 kg)

Initially 2500 units, then

First-line fragment. Read the complete Indications and Dose section above.

PDF page 161

Adult (body-weight 90 kg and above)

Initially 3750 units,

First-line fragment. Read the complete Indications and Dose section above.

PDF page 162

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Danaparoid sodium

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 161, 162

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF pages 161, 162

Contra Indications

PDF page 162

Cautions

Antibodies to heparins (risk of antibody- induced thrombocytopenia). body-weight over 90 kg. recent bleeding. risk of bleeding Elderly. severe hypertension

PDF page 162

Allergy And Cross Sensitivity

Hypersensitivity to unfractionated or low molecular weight heparin.

PDF page 162

Safety

Interactions

→Appendix 1: danaparoid

PDF page 162

Side Effects

PDF page 162

Pregnancy

Manufacturer advises avoid—limited information available but not known to be harmful.

PDF page 162

Breast Feeding

Amount probably too small to be harmful but manufacturer advises avoid.

PDF page 162

Hepatic Impairment

PDF page 162

Renal Impairment

PDF page 162

Monitoring Requirements

PDF page 162

Dose and formulations

Directions For Administration

For intravenous infusion, give continuously in Glucose 5% or Sodium chloride 0.9%.

PDF page 162

Medicinal Forms

PDF page 162

Dose text by age group

Adult

750 units twice daily for 7–10 days, initiate

First-line fragment. Read the complete Indications and Dose section above.

PDF page 161

Adult (body-weight up to 55 kg)

Initially 1250 units, then

First-line fragment. Read the complete Indications and Dose section above.

PDF page 161

Adult (body-weight 55–89 kg)

Initially 2500 units, then

First-line fragment. Read the complete Indications and Dose section above.

PDF page 161

Adult (body-weight 90 kg and above)

Initially 3750 units,

First-line fragment. Read the complete Indications and Dose section above.

PDF page 162

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.