Nadroparin calcium

Nadroparin Calcium is a low molecular weight heparin (LMWH) with anticoagulant properties, used primarily in the prevention and treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE). It is also employed in the management of unstable angina and non-Q wave myocardial infarction, as well as for the prevention of clotting during hemodialysis. Nadroparin calcium works by inhibiting factor Xa and IIa, which are critical components of the blood coagulation pathway, thereby reducing the ability of blood to form clots.

Pharmacology

Nadroparin calcium exerts its anticoagulant effect by binding to antithrombin III (ATIII), enhancing the inactivation of factor Xa and, to a lesser extent, factor IIa (thrombin). This inhibition is crucial for the anticoagulant pathway, as it prevents the conversion of fibrinogen to fibrin, a key step in clot formation. The drug's low molecular weight allows it to have a more predictable anticoagulant response compared to unfractionated heparin, making it possible to administer it in fixed doses without the need for routine monitoring of the activated partial thromboplastin time (aPTT).

Indications

Nadroparin calcium is indicated for:

• Prevention of deep vein thrombosis (DVT), which can lead to pulmonary embolism in patients undergoing surgery.
• Treatment of acute deep vein thrombosis with or without pulmonary embolism.
• Prevention of clotting in the extracorporeal circulation during hemodialysis.
• Treatment of unstable angina and non-Q wave myocardial infarction, in conjunction with aspirin.

Administration and Dosage

Nadroparin calcium is administered subcutaneously. The dosage depends on the indication, the patient's weight, and clinical condition. For the prevention of DVT, the dosage may vary depending on the patient's risk factors and type of surgery. For the treatment of acute DVT or unstable angina, the dosage is typically higher and may require adjustment based on the patient's response to the treatment.

Side Effects

The most common side effect of nadroparin calcium is bleeding. Other possible side effects include thrombocytopenia (a decrease in the number of platelets), hypersensitivity reactions, including skin rash, and, rarely, osteoporosis with long-term use. It is essential to monitor patients for signs of bleeding and thrombocytopenia during treatment.

Contraindications

Nadroparin calcium is contraindicated in patients with:

• Active major bleeding.
• Hypersensitivity to nadroparin calcium, heparin, or any components of the formulation.
• History of heparin-induced thrombocytopenia (HIT).
• Severe renal impairment, due to the risk of accumulation and increased bleeding risk.

Drug Interactions

Nadroparin calcium can interact with other medications that affect blood clotting, including antiplatelet agents, other anticoagulants, and nonsteroidal anti-inflammatory drugs (NSAIDs), increasing the risk of bleeding. It is crucial to inform healthcare providers of all medications being taken to manage potential interactions appropriately.

Pharmacokinetics

Nadroparin calcium is absorbed rapidly after subcutaneous injection, with peak anti-factor Xa activity observed about 4 hours post-dose. Its bioavailability is close to 100%. The drug is metabolized in the liver and excreted primarily by the kidneys. Due to its renal excretion, dose adjustments may be necessary in patients with renal impairment to prevent accumulation and bleeding.