Name: DANAPAROID (OrgaranR)
Classification: antithrombotic
  • mixture of low molecular weight sulfated glycosaminoglycurans derived from porcine intestinal mucosa
  • devoid of heparin or heparin fragments 
  • safe for anticoagulation of patients with heparin induced thrombocytopenia (HIT syndrome) or heparin allergy
  • binds to antithrombin III, leading to anti-Xa activity
Dose:
  • DVT prophylaxis:
    • < 90 kg:  750 units sc q12h
    • >90 kg:  1250 units sc q12h or 750 units sc q8h
  • Treatment for DVT or Pulmonary Embolus:
    • Bolus, IV Direct:
      • if < 55 kg: 1250 u IV
      • if 55-90 kg: 2500 u IV
      • if > 90 kg: 3750 u IV
    • Maintenance Dose:
      • Continuous IV infusion at 400 u/hr X 4 hours, then:
      • 300 u/hr X 4 hours, then:
      • continue at 200 u/hr and adjust to maintain anti-Xa levels between 0.5-0.8u/ml (normal anti-Xa is 0 u/ml; prolonged by heparin or danaparoid)
    OR
      • if < 55 kg: 1500 u sc q12h
      • if 55-90 kg: 2000 u sc q12h
      • if > 90 kg; 1750 u sc q8h
  • Continuous Renal Replacement Therapy (CRRT)
    • Bolus - IV Direct: 
      • for first dialysis: 3750 u IV Direct (if < 55 kg, give 2500 u)
      • for subsequent dialysis: 
        • if anti-Xa <0 .3 u/mL; give 3000 u IV direct (if < 55 kg, give 2,000 u)
        • if anti-Xa 0 .3-0.35 u/mL, give 2500 u IV direct (if < 55 kg, give 1500 u)
        • if anti-Xa 0.35-0.4 u/mL, give 2000 u IV direct (if < 55 kg, give 1500 u)
        • if anti-Xa >0.4 u/mL, do not re-bolus (if fibrin clots are present and anti-Xa is > 0.4 u/mL, give 1500 u regardless of weight)
    • Infusion: 
      • 400 u/hr X 6 hours then:
      • continue at 200 u/hr
Administration: IV Infusion:
2250 u in 250 mL D5W or NS
Adverse Effects:
  • hemorrhage
  • skin rash; generalized or around injection site
Caution:
  • may need to reduce dose in renal failure; is not cleared by dialysis 
Antidote:
  • no specific antidote; may consider fresh frozen plasma
  • plasmapheresis may be used 
Monitoring Therapy:
  • anti-Xa activity (usually done once daily until levels stabilize; requires hematology approval)
  • does not affect INR or PTT
  • platelet count
  • hemoglobin
  • creatinine, urine output
  • signs of bleeding
  • skin condition
CCTC Protocol:
  • May be administered sc by any RN
  • May be administered by IV infusion by an approved RN in CCTC.
  • Continuous infusion must be administered by infusion pump.


Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC
Last Update: August 7, 2006

LHSCHealth Professionals

Last Updated March 24, 2009 | © 2007, LHSC, London Ontario Canada