Bemiparin sodium

CLINICAL USE

Prophylaxis of thromboembolic disorders of venous origin

Treatment of deep vein thrombosis and pulmonary embolism

Anticoagulation of the extracorporeal circulation during haemodialysis

DOSE IN NORMAL RENAL FUNCTION

Prophylaxis DVT:

Moderate risk surgery, 2500 units once —daily for 7–10 days

High risk surgery, 3500 units once daily —for 7–10 days

Treatment DVT and PE: 115 units/kg every 24 hours for 5–9 days

Anticoagulation of extracorporeal circuits – see ‘Other Information’

PHARMACOKINETICS

Molecular weight :3600 (3000–4200)

%Protein binding :–

%Excreted unchanged in urine : –

Volume of distribution (L/kg) :–

half-life – normal/ESRD (hrs) :5–6

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function for prophylaxis only.

<10 : Dose as in normal renal function for prophylaxis only.

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Not dialysed. Dose as in GFR <10 mL/min

HD :Not dialysed. Dose as in GFR <10 mL/min

HDF/high flux :Dialysed. Dose as in GFR

<10 : mL/min

CAV/VVHD :Not dialysed. Dose as in GFR=10–20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Analgesics: increased risk of bleeding with NSAIDs – avoid concomitant use with IV diclofenac; increased risk of haemorrhage with ketorolac – avoid concomitant usedrotrecogin alfa: manufacturer advises to avoid use of high doses of heparin with drotrecogin alfa

Nitrates: GTN infusions increase the excretion of bemiparin; anticoagulant effect reduced

Use with care in patients receiving oral anticoagulants, platelet aggregation inhibitors, aspirin or dextran

ADMINISTRATION

Reconstition

–

Route

Rate of Administration

–

Comments

–

OTHER INFORMATION

In extracorporeal circulation during a 4-hour or less haemodialysis session, for patients <60 kg, 2500 units bemiparin is administered into the arterial line of the circuit at the beginning of the session; for patients >60 kg, 3500 units bemiparin is used

Additional doses may be required if using LMWHs for anticoagulation in HDF

1.4 mg of protamine should neutralise the effect of 100 units of bemiparin

Low molecular weight heparins are renally excreted and hence accumulate in severe renal impairment. While the doses recommended for prophylaxis against DVT and prevention of thrombus formation in extracorporeal circuits are well tolerated in patients with ESRF, the doses recommended for treatment of DVT and PE have been associated with severe, sometimes fatal, bleeding episodes in such patients. Hence the use of unfractionated heparin would be preferable in these instances

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