Subject(s)
Anticoagulants/adverse effects , Antithrombins/therapeutic use , Heparin/adverse effects , Hirudins/analogs & derivatives , Pipecolic Acids/therapeutic use , Thrombocytopenia/chemically induced , Thrombocytopenia/drug therapy , Antithrombins/economics , Antithrombins/pharmacology , Arginine/analogs & derivatives , Blood Coagulation/drug effects , Blood Coagulation Tests , Chondroitin Sulfates/economics , Chondroitin Sulfates/pharmacology , Chondroitin Sulfates/therapeutic use , Critical Care/methods , Dermatan Sulfate/economics , Dermatan Sulfate/pharmacology , Dermatan Sulfate/therapeutic use , Drug Combinations , Drug Costs , Drug Monitoring/methods , Heparitin Sulfate/economics , Heparitin Sulfate/pharmacology , Heparitin Sulfate/therapeutic use , Hirudins/economics , Hirudins/pharmacology , Humans , Pipecolic Acids/economics , Pipecolic Acids/pharmacology , Recombinant Proteins/economics , Recombinant Proteins/pharmacology , Recombinant Proteins/therapeutic use , Sulfonamides , Thrombocytopenia/classificationABSTRACT
Danaparoid sodium (Orgaran, Organon) is a heparinoid glycosamino-glycuronan antithrombotic agent approved for the prophylaxis of post-operative deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE) in patients undergoing elective hip replacement surgery. Danaparoid is a low molecular weight heparinoid consisting of a mixture of heparan sulphate (84%), dermatan sulphate (12%) and small amounts of chondroitin sulphate (4%), whose antithrombotic activity has been well established. Its pharmacological effect is exerted primarily by inhibiting Factors Xa (FXa) and IIa (FIIa) at a ratio greater than heparin, with a minimal effect on platelet function. Danaparoid exhibits low cross-reactivity with heparin-induced antibodies when compared with heparin or low molecular weight heparins (LMWH), thereby making it an excellent choice for the management of heparin-induced thrombocytopenia (HIT). It has excellent bioavailability following s.c. injection. Danaparoid has little effect on routine coagulation tests (activated partial thromboplastin time [aPTT], prothrombin time [PT], and thrombin time [TT]). Patients with elevated serum creatinine should be monitored carefully. For its FDA approved indication (DVT prophylaxis during hip replacement surgery), its cost per day is approximately eight times more than LMWH. Even though monitoring is not routinely necessary according to the manufacturer for its approved indication, monitoring is frequently necessary when it is used in other clinical scenarios. Its higher cost than comparable therapies for DVT prophylaxis and the low availability of the FXa assay in most non-tertiary care hospitals has limited the widespread use of danaparoid. Danaparoid has been found to be effective in the treatment of HIT although this is an off label use, despite being the most frequent reason why danaparoid is used.