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Danaparoid sodium parenteral

Updated 2 Feb 2023 | Parenteral anticoagulants


Injection containing danaparoid sodium

Drugs List

  • danaparoid sodium 750unit/0.6ml injection
  • Therapeutic Indications


    Anticoagulation in heparin-induced thrombocytopenia (HIT) type II
    Prevention of deep vein thrombosis in patients undergoing surgery


    Plasma anti Xa activity has a linear relationship to dose.
    A functional antifactor Xa test should be used if anticoagulant activity monitoring or dose individualisation is required. Use danaparoid as the standard for construction of the reference curve and the test should be carried out using a chromogenic peptide substrate.


    Non Heparin Induced Thrombocytopenia (HIT) (Deep Vein Thrombosis (DVT) prophylaxis)
    Subcutaneous injection of 750units twice daily for seven to ten days or until thromboembolism risk has diminished.
    In surgical patients, dosing should start pre-operatively with the last pre-operative dose being given 1 to 4 hours before the start of surgery.

    Heparin Induced Thrombocytopenia (HIT)
    Initial dose as an intravenous bolus injection, followed by intravenous infusion.

    Patients weighing less than 55kg
    Initial dose: Intravenous bolus injection of 1250units, followed by
    Maintenance dose: Intravenous infusion of 400units/hour for 2 hours, then 300units/hour for 2 hours, then 200units/hour for five days.
    Patients weighing 55kg to 90kg:
    Initial dose: Intravenous bolus injection of 2500units, followed by
    Maintenance dose: Intravenous infusion of 400units/hour for 2 hours, then 300units/hour for 2 hours, then 200units/hour for five days.
    Patients weighing over 90kg:
    Initial dose: Intravenous bolus injection of 3750units, followed by
    Maintenance dose: Intravenous infusion of 400units/hour for 2 hours, then 300units/hour for 2 hours, then 200units/hour for five days.

    Expected plasma anti-Xa levels are 0.5units/ml to 0.7units/ml five to ten minutes after the bolus, less than or equal to 1unit/ml during the stepped infusion phase and 0.5units/ml to 0.8units/ml during the maintenance.


    Thromboembolic disease in children with history of HIT (unlicensed)

    Children aged 16 to 18 years
    Initial dose: 2500units (maximum 1250units if bodyweight under 55kg, 3750 units if over 90kg) by intravenous injection.
    Maintenance dose: By continuous intravenous infusion, 400units/hour for 2 hours then 300units/hour for 2 hours, then 200units/hour for five days titrated accordingly.

    Children aged 1 month to 16 years:
    Initial dose: 30units/kg (maximum 1250units if bodyweight under 55kg, 2500units if over 55kg) by intravenous injection.
    Maintenance dose: By continuous intravenous infusion, 1.2 to 2units/kg/hour titrated accordingly.


    Thromboembolic disease in neonates with history of HIT (unlicensed)
    Initial dose: 30units/kg by intravenous injection.
    Maintenance dose: By continuous intravenous infusion, 1.2 to 2units/kg/hour titrated accordingly.

    Additional Dosage Information

    Conversion to oral anticoagulants is possible although it is advisable only to start this after adequate antithrombotic control is achieved with danaparoid.

    Oral anticoagulants may be given with the infusion running at a maximum rate of 300units/hour. The infusion can be stopped when the international normalised ratio (INR) is greater than or equal to 1.5.

    If the risk of bleeding is high then, either:
    a) Stop the danaparoid infusion and start danaparoid subcutaneous injection at 750units twice daily. Start oral anticoagulants 24 hours later. Withdraw danaparoid 48 to 72 hours later to allow the prothrombin time and INR to reach therapeutic levels.

    Note: Measurement of prothrombin time and INR is not reliable within 5 hours of danaparoid injection.


    b) Stop the danaparoid infusion. Start oral anticoagulants 12 hours later. Monitor prothrombin time and INR to achieve therapeutic levels with oral anticoagulant.


    Prevention of deep vein thrombosis.
    For subcutaneous injection administration.

    Treatment of thrombo-embolic disorders in patients who have developed or have a history of heparin-induced thrombocytopenia (HIT).
    For intravenous injection followed by intravenous infusion administration.


    Haemorrhagic diathesis
    Acute bacterial endocarditis
    Diabetic retinopathy
    Haemorrhagic stroke
    Idiopathic thrombocytopenic purpura
    Peptic ulcer - unless this is the reason for surgery
    Positive aggregation test for heparin induced Ab causing thrombocytopenia
    Severe hepatic disorder
    Severe hypertension
    Severe renal impairment

    Precautions and Warnings

    Children under 18 years
    Predisposition to haemorrhage
    Spinal/epidural anaesthesia
    Gastrointestinal ulcer
    Impaired haemostasis
    Ischaemic cerebrovascular accident
    Moderate hepatic impairment
    Moderate renal impairment

    Avoid locoregional anaesthesia when anticoagulant used at treatment doses
    Refer to product information for use in peridural/spinal anaesthesia
    Some contraindications are relative - refer to product information
    Contains sulfite. Discontinue if hypersensitivity reactions occur
    Monitor platelets before starting and during treatment
    Monitor anti-Xa activity in patients over 90kg
    Monitor anti-Xa activity in renal impairment
    Monitor patients undergoing spinal or epidural anaesthesia closely
    Test for platelet cross reactivity in patients sensitive to heparin
    Discontinue if thrombocytopenia occurs
    Spinal anaesthesia: tell patient-report symptoms of neurological impairment
    Prothrombin time and INR unreliable within 5 hours of injection

    Danaparoid has a low incidence of platelet cross-reactivity with plasma from patients sensitised by heparin and it is therefore advisable to rule this out using an in-vitro aggregation test prior to treatment. The platelet count should be checked daily during the first week of treatment, on alternate days during the second and third weeks, and weekly to monthly thereafter. If a pre-treatment cross reactivity test with danaparoid is positive but the decision to use danaparoid is taken, then daily platelet counts are advised until danaparoid treatment is stopped. Therapy should be discontinued if antibody-induced thrombocytopenia occurs and alternative treatment considered.

    No incidences of osteoporosis have been reported with the use of recommended doses, however, inappropriate doses of glycosaminoglycuronan may result in osteoporosis.

    Since severe bleeding may occur post-operatively in HIT patients undergoing a cardiopulmonary bypass procedure, danaparoid is not recommended during the procedure unless no other antithrombotic treatment is available.

    Note that the anti-Xa units of danaparoid have a different relationship to clinical efficacy from those of heparin and low molecular weight heparins.

    Locoregional anaesthesia is contraindicated where danaparoid is being used for treatment rather than prophylaxis.

    When considering the interval between the last administration of a prophylactic dose of danaparoid and the placement or removal of a peridural or spinal catheter the product characteristics and patient profile should be taken in to account. Subsequent doses should not occur before at least 4 hours have elapsed and re-administration should be delayed until completion of the surgical procedure.

    When danaparoid is used in the context of peridural or spinal anaesthesia, extreme vigilance and frequent monitoring for signs and symptoms of neurological impairment must be carried out. Back pain, sensory and motor deficits (numbness and weakness) and bladder or bowel dysfunction should be considered and patients advised to inform staff immediately that any of these occur. Urgent diagnosis and treatment including spinal cord decompression should be initiated.

    Plasma anti-Xa activity monitoring using an amidolytic assay is recommended in patients weighing over 90 kg.

    Avoid in severe renal and hepatic impairment unless the patient has heparin induced thrombocytopenia and no alternative anti-thrombotic treatment is available.

    Pregnancy and Lactation


    Use danaparoid with caution in pregnancy.

    At the time of writing there is limited data on the use of danaparoid during pregnancy. The manufacturer states that if alternative antithrombotic treatment is unacceptable, danaparoid can be used.

    Danaparoid has been used with success in a small number of pregnancies, however the available information is considered to be insufficient to assess its safety in pregnancy.

    Danaparoid has a molecular weight of about 6500 daltons, and therefore it is likely that it will not cross the placenta. Schaefer (2007) concludes that in cases of heparin - induced thrombocytopenia danaparoid may be prescribed during pregnancy.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Use danaparoid with caution in breastfeeding.

    At the time of writing there is limited data on the use of danaparoid during breastfeeding.

    There is no data available regarding danaparoid secretion into human breast milk. It would not be expected to be excreted into breast milk due to its molecular weight, therefore amounts in breast milk are probably too small to be harmful and would be inactivated in the gastrointestinal tract. Schaefer (2007) concludes that theoretically, no problems should be expected for the breastfed infant and weaning does not seem to be justified.

    The manufacturer states that if an alternative antithrombotic treatment is unacceptable, danaparoid can be used during breastfeeding.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Bleeding (surgical site)
    Bruising at injection site
    Epidural haematoma
    Erythematous rash
    Hypersensitivity reactions
    Immunologically mediated thrombocytopenia
    Injection site reactions
    Irritation (injection site)
    Local pain (injection site)
    Maculopapular rash
    Rash at injection site
    Spinal Haematoma
    Swelling (injection site)


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: August 2016

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

    Summary of Product Characteristics: Danaparoid sodium 750 anti-Xa units, solution for injection. Aspen. Revised January 2016.

    NICE - Evidence Services
    Available at:
    Last accessed: 27 June 2017.

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