Nadroparin

Prophylaxis of thromboembolic disorder:

CrCl (mL/min)	Dosage
≥30 to <50 and <30	Reduce dose by 25-33%.

Thromboembolic disorders; Unstable angina; Non-Q wave myocardial infarction:

CrCl (mL/min)	Dosage
≥30 to <50	Reduce dose by 25-33%.
<30	Contraindicated.

Active bleeding or increased risk of haemorrhage related to haemostasis disorders (except disseminated intravascular coagulation not heparin-induced); haemorrhagic CVA, organic lesions likely to bleed (e.g. active peptic ulcer), history of thrombocytopenia with nadroparin; acute infectious endocarditis. Severe renal impairment (CrCl <30 mL/min) when used for the treatment of thromboembolic disorders, unstable angina, and non-Q wave MI.

Patient with severe arterial hypertension, history of gastrointestinal ulceration, vascular disorder of chorio-retina, hepatic failure, risk factors for hyperkalaemia (e.g. diabetes mellitus, metabolic acidosis, haematoma in body tissues, use of ACE inhibitors, NSAIDs, K-sparing diuretics or K supplements). Patients who are undergoing knee surgery, spinal puncture, or receiving neuraxial anaesthesia (spinal or epidural anaesthesia); postoperative period after brain, spinal cord or eye surgery. Not interchangeable (unit for unit) with any other LMWHs or heparin. Not intended for IM administration. Hepatic and moderate renal (CrCl ≥30 to <50 mL/min) impairment. Elderly. Pregnancy and lactation.

Significant: Haemorrhage at any site, thrombocytopenia with thrombosis, heparin-induced thrombocytopenia, hyperkalaemia, prosthetic valve thrombosis; epidural or spinal haematomas including subsequent chronic or permanent paralysis (in patients receiving neuraxial anaesthesia or undergoing spinal puncture). Rarely, cutaneous necrosis (preceded by purpura, infiltrated or painful erythematous blotches).
Blood and lymphatic system disorders: Rarely, eosinophilia (reversible).
General disorders and administration site conditions: Inj site haematoma and reaction.
Immune system disorders: Rarely, hypersensitivity reactions.
Investigations: Increased transaminases (transient).
Nervous system disorders: Headache, migraine.
Reproductive system and breast disorders: Rarely, priapism.
Skin and subcutaneous tissue disorders: Rarely, rash, erythema, urticaria, pruritus.

Monitor platelet count at baseline and twice weekly during treatment; antifactory Xa levels at least 4 hours postdose as clinically indicated; stool occult blood tests, Hb, LFT, renal function; plasma K levels in patients at risk of hyperkalaemia. Closely monitor for signs and symptoms of bleeding, thrombocytopenia with thrombosis and neurological impairment, and clotting in the dialysis circuit (when used during haemodialysis).

Symptom: Haemorrhage. Management: Administer protamine sulfate (0.6 mL neutralises approx 950 anti-Xa IU nadroparin) in serious cases. Monitor platelet and other coagulation parameters.

Increased risk of bleeding with aspirin, antiplatelet agents and NSAIDs. May enhance the hyperkalaemic effect of ACE inhibitors and K-sparing diuretics.

Description:
Mechanism of Action: Nadroparin is a LMWH with an average molecular weight of approx 4,300 daltons. It binds to antithrombin III, thereby accelerating the inhibition of several clotting factors, specifically factor Xa.
Pharmacokinetics:
Absorption: Bioavailability: Approx 88% (SC). Time to peak plasma concentration: Within 10 minutes (IV); 3-6 hours (SC).
Distribution: Volume of distribution: 3.59 L.
Metabolism: Metabolised in the liver.
Excretion: Mainly via urine. Elimination half-life: Approx 3.5 hours (SC).

Store between 15-30°C. Do not refrigerate or freeze.

Thuốc kháng đông, chống kết dính tiểu cầu & tiêu sợi huyết

Anon. Nadroparin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 07/09/2021.

Buckingham R (ed). Nadroparin Calcium. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 07/09/2021.

Fraxiparine (Aspen Medical Products Malaysia Sdn Bhd). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 07/09/2021.

Fraxiparine/Fraxiparine Forte (Aspen Pharmacare). MIMS Singapore. http://www.mims.com/singapore. Accessed 07/09/2021.