Nadroparin

Nadroparin calcium is a low molecular weight heparin (LMWH) derived from porcine sources by depolymerization of heparin. It is used as an anticoagulant to prevent and treat thromboembolic disease, including deep vein thrombosis (DVT), pulmonary embolism (PE), and certain acute coronary syndromes.

Mechanism of action is via binding to antithrombin III, which accelerates the inhibition of factor Xa and, to a lesser extent, thrombin (factor IIa). This results in a more predictable anticoagulant effect than unfractionated heparin and generally requires less routine laboratory monitoring. However, anti-Xa activity can be measured in selected patients to adjust dosing.

Administration and dosing are by subcutaneous injection. Dosing regimens vary by indication (prophylaxis versus treatment) and are often weight-based. The drug has a relatively rapid onset and a longer duration of action compared with unfractionated heparin, enabling once or twice daily dosing. Pharmacokinetics are characterized by good bioavailability after subcutaneous administration and primary renal elimination; activity may be prolonged in renal impairment.

Safety and monitoring considerations include the risk of bleeding as the primary adverse effect. Thrombocytopenia including heparin-induced thrombocytopenia (HIT) can occur, but the risk is lower than with unfractionated heparin. Other potential adverse effects include injection-site reactions and, with long-term use, osteoporosis. Routine coagulation tests are not required for all patients, though platelet counts and, in some cases, anti-Xa levels may be monitored.

Contraindications include active major bleeding, history of HIT, and known hypersensitivity to nadroparin or heparins. Caution is advised with neuraxial anesthesia due to the risk of spinal or epidural hematoma. Nadroparin is used during pregnancy when anticoagulation is indicated, under medical supervision. It is marketed under brand names such as Fraxiparine and Fraxodi.