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Indications and Dosage
Subcutaneous
Prophylaxis of postoperative venous thromboembolism Adult: For general surgical procedures: As sodium: Inj of 3200 units 2 hr before the procedure, followed by 3200 units once daily for 7 days or until the patient is fully ambulant. For higher risk surgery or orthopaedic patients: As sodium: Inj of 4250 units 12 hr before the procedure, followed by 4250 units 12 hr post-op and then once daily for 10 days. Subcutaneous Thromboembolic disorders Adult: As sodium: Inj of 6400 units for 7-10 days.
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Contraindications
Do not give by IM. History of thrombocytopenia with heparin; positive in-vitro platelet aggregation test (cross-reactivity) with parnaparin; bacterial endocarditis; haemorrhagic CVA; conditions or diseases with increased risk of haemorrhage.
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Special Precautions
Elderly, renal or hepatic impairment, extremes of body weight, hypertension, or other patients with increased risk of bleeding; post-operative period following brain or spinal cord surgery; spinal anaesthesia or analgesia. Pregnancy and lactation. Not generally recommended for use in patients with prosthetic heart valves as they may not provide adequate prophylaxis against thromboembolism even at high doses. Monitor platelet counts in long-term treatments. Do not switch from one brand of LMWH to another during treatment.
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Adverse Reactions
Hyperkalaemia related to hypoaldosteronism; bleeding; thrombocytopenia; urticarial rash or hypersensitivity skin reactions; skin necrosis reactions (localised to or distant from the inj site); increase in transaminases.
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Overdosage
Haemorrhage; treatment of severe bleeding may be reduced by slow IV admin of protamine sulfate.
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Drug Interactions
Increased risk of haemorrhage with oral anticoagulants or drugs (e.g. aspirin and dipyridamole) that affect platelet function; NSAIDs; dextrans, thrombolytic enzymes such as streptokinase, high doses of penicillins and some cephalosporins, some contrast media, asparaginase, and epoprostenol; alcohol. Hyperkalaemia in patients on ACE inhibitors. Reduced activity if given by IV with IV glyceryl trinitrate. Reduced half-life with tobacco.
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Action
Description: Parnaparin is a LMWH with antithrombotic activity. It enhances the action of antithrombin III but, unlike heparin, it is characterised by a higher ratio of anti-factor Xa to anti-factor IIa (antithrombin) activity. It also has less effect on platelet aggregation than heparin; and has no significant effect on blood coagulation tests such as aPTT.
Pharmacokinetics: Distribution: Mainly in blood. Metabolism: Renal and hepatic. Peak plasma levels of anti-Xa activity: 3 hr; Plasma half-life: 6 hr. The anti-Xa activity persists in plasma for 20 hr after single dose. Excretion: Via urine. |
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Storage
Store at ≤30°C.
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