Orgaran (danaparoid) / Merck (MSD) - LARVOL DELTA

When pregnancy, HIT, and stroke collide: Navigating complex thrombotic care in a community-based setting (ASH 2025) - "Case Presentation: A 30-year-old woman, gravida 1 para 0, with a history of unprovoked lower extremity deep vein thrombosis (DVT) on chronic rivaroxaban for secondary prophylaxis was transitioned to low-molecular-weight heparin (enoxaparin) upon confirmation of pregnancy at 7 weeks' gestation...Enoxaparin was discontinued, and argatroban was initiated post-EVT, later transitioning to subcutaneous danaparoid, and ultimately fondaparinux for the remainder of her pregnancy...Another important feature of this case is that it was successfully managed entirely within a regional community hospital system, allowing the patient to stay close to her family and access local rehabilitation services. This case report highlights the ability of community-based hospitals to provide high-acuity, patient-centered care through strong interdisciplinary collaboration."

Cardiovascular • Hematological Disorders • Infectious Disease • Novel Coronavirus Disease • Thrombocytopenia • Thrombosis

Platelet dynamics and clinical outcomes in patients with heparin-induced thrombocytopenia – single center experience (ASH 2025) - "Several agents, such as bivalirudin, argatroban, danaparoid, and fondaparinux, have been used for the treatment of HIT. The dynamics of platelet counts after diagnosis may be an important tool for assessing treatment efficacy. Despite treatment, the mortality rate in critically ill patients with HIT remains high."

Clinical • Clinical data • Cardiovascular • Hematological Disorders • Thrombocytopenia

Heparin-induced thrombocytopenia after percutaneous coronary intervention complicated by hemothorax and pulmonary thromboembolism: The scylla and charybdis of hematology (ASH 2025) - "Those with a confirmed diagnosis need to be started on therapeutic-dose anticoagulation with argatroban, danaparoid, bivalirudin, or fondaparinux. Our case highlights a unique case of HIT with both thrombosis and life-threatening bleeding post-PCI that precluded the use of both anticoagulation and antiplatelets, underscoring the complexity of care, need for a multidisciplinary approach, and individualization of treatment in such cases."

Cardiovascular • Cerebral Hemorrhage • Chronic Kidney Disease • Diabetes • Endocrine Disorders • Hematological Disorders • Hypertension • Metabolic Disorders • Nephrology • Pulmonary Embolism • Renal Disease • Respiratory Diseases • Thrombocytopenia

Evaluating the Safety of Combining Tyrosine Kinase Inhibitors with Anticoagulants in Chronic Myeloid Leukemia : A Systematic Review (ASH 2024) - "Of the 3 retrospective studies, 2 reported no bleeding or thrombotic events with the combinations of ponatinib and prophylactic apixaban (5 patients) or imatinib with warfarin (9 patients) in CML patients. The third study reported the incidence of 2 intramuscular hematoma events with the combinations of edoxaban with imatinib (with severe renal failure leading to edoxaban discontinuation) and rivaroxaban with nilotinib (with moderate renal failure leading to rivaroxaban dose reduction).Five identified case reports (n(total cases)= 8) did not identify any bleeding events with the combinations of apixaban with dasatinib or imatinib (n= 2), warfarin with nilotinib or dasatinib (n= 1), therapeutic heparin with imatinib (n= 1), and imatinib with the combination of rivaroxaban with ticagrelor (n= 1). One study reported worsening of disseminated intravascular coagulation with the combination of imatinib and prophylactic danaparoid in a patient in blast phase of CML that..."

Clinical • Review • Atrial Fibrillation • Cardiovascular • Chronic Myeloid Leukemia • Hematological Disorders • Hematological Malignancies • Leukemia • Oncology • Renal Disease • Thrombosis

LMWH-Associated Skin Necrosis in Heparin-Induced Thrombocytopenia Type II: A Case Requiring Complex Interdisciplinary Wound Management (EADV 2025) - "Materials & An 83-year-old woman was referred with necrotic plaques on both upper thighs and the lower left abdomen, localized to prior LMWH (enoxaparin) injection sites. This case reinforces the need to recognize skin necrosis as a manifestation of HIT II. In suspected cases, the 4Ts score should guide further testing. Immediate discontinuation of heparin, lifelong avoidance, and initiation of non-heparin anticoagulants such as danaparoid, argatroban or fondaparinux are essential to prevent thrombotic complications."

Clinical • Cardiovascular • Hematological Disorders • Immunology • Musculoskeletal Diseases • Orthopedics • Pulmonary Embolism • Respiratory Diseases • Thrombocytopenia

A singular case of refractory paraneoplastic heparin independent antiPF4-related thrombotic disorder (ISTH 2025) - "After prednisone withdrawal, in December 2024, Fostamatinib 200 mg daily was started...As hyperfibrinolysis signs appeared, a tranexamic acid course per os was also started. Results After starting pembrolizumab in November 2024, results on coagulopathy and platelet count were not appreciable. In December 2024, under Danaparoid and Fostamatinib (acetylsalicylic acid withdrawn after further platelet count fall in November 2024), he was admitted to Cardiology Unit (different hospital) after pulmonary embolism and myocardial infarction and died. At admission platelet count raise was finally appreciable, but coagulopathy was still present. Table or Figure Upload"

Clinical • Immune Thrombocytopenic Purpura • Immunology • Lung Cancer • Myocardial Infarction • Obesity • Oncology • Pulmonary Embolism • Respiratory Diseases • Solid Tumor • Thrombocytopenia • Thrombocytopenic Purpura • Thrombosis

Bleeding and Thrombosis Risks with Danaparoid Sodium in HIT: A Retrospective Study (ISTH 2025) - "Longer duration of danaparoid treatment, lower first anti-Xa level (0.3 U/mL IQR 0.3–0.5 vs 0.5 IQR 0.4–0.7) and high number of days with anti-Xa under the target (16 IQR 9–24 vs 1 IQR 0–6) were identified as risk factors for thrombosis. Indeed, the first anti-Xa was lower in the thrombosis group (median 0.3 UI/mL IQR 0.3–0.5) compared to the non-thrombosis group (0.5 UI/mL IQR 0.4–0.7, p=0.028)."

Retrospective data • Cardiovascular • Hematological Disorders • Thrombocytopenia • Thrombosis

"Keep HIT in Mind and Take Care". Multiple Tips From a Single Patient. (PubMed, Int Med Case Rep J) - "Discontinuation of warfarin could lead to catastrophic consequences if an unrecognized HIT is ongoing, and an alternative anticoagulant is not started. Bivalirudin and danaparoid were used after the diagnosis of HIT, adapting anticoagulant therapy to the needs of recent surgery."

Journal • Cardiovascular • Hematological Disorders • Thrombocytopenia • Thrombosis

Danaparoid failure in heparin-induced thrombocytopenia due to acquired antithrombin deficiency: A case report. (PubMed, Thromb Res) - "This is the first reported case of danaparoid failure due to a documented AT deficiency demonstrating the potential efficacy of AT supplementation in this context. This case highlights the importance of monitoring AT levels in HIT patients when danaparoid activity is below the therapeutic range despite adjusted dosing."

Journal • Cardiovascular • Hematological Disorders • Oncology • Sarcoma • Solid Tumor • Thrombocytopenia

Comparison of adverse drug reactions of heparin and its derivates in the European Economic Area based on data from EudraVigilance between 2017 and 2021. (PubMed, Clin Nephrol) - "The reporting rates of ADRs for heparin and its derivates were all very low. In comparison, the reporting rate of ADRs for danaparoid and fondaparinux was relatively high. The most commonly reported ADRs were hemorrhage, thrombocytopenia, followed by injection-site reactions and hypersensitivity."

Adverse drug reaction • Journal • Hematological Disorders • Hepatology • Immunology • Liver Failure • Orthopedics • Renal Disease • Thrombocytopenia

PROPHYLACTIC USE OF DANAPAROID AFTER LIVER TRANSPLANT IN HEPARIN-INDUCED THROMBOCYTOPENIA (HIT): A CASE REPORT (SIE 2024) - "A switch from LMWH to fondaparinux (FO) (2.5 mg daily) was opted for...At 1-month follow-up, the DVT had resolved, but given the need for ACT to maintain flow in the TIPS in view of liver transplantation (LT), a switch to a treatment with DAPT + Warfarin and then only with Clopidogrel...Prophylaxis was continued for another two months with FO (2.5 mg daily) and, at the end of two months, acetylsalicylic acid (75 mg daily) was started...Conclusions. We report the first case of successful and prolonged use of DA at prophylactic dose in prevention of thrombotic complications after LT in a patient with previous diagnosis of HIT."

Case report • Clinical • Cardiovascular • Cerebral Hemorrhage • Fibrosis • Hematological Disorders • Hepatology • Hypertension • Immunology • Liver Cirrhosis • Myocardial Infarction • Thrombocytopenia • Thrombosis • Transplantation

Antithrombotic Efficacy and Bleeding Risks of Vaccine-Induced Immune Thrombotic Thrombocytopenia Treatments. (PubMed, Blood Adv) - "Here, we examined the effects of various anticoagulants (including unfractionated (UF) heparin, danaparoid, bivalirudin, fondaparinux, and argatroban), IVIg, and the FcγRIIa receptor-blocking antibody, IV.3. Our results underscore the necessity of animal model investigations to inform and better guide clinicians on treatment choices. This study provides compelling evidence for developing FcγRIIa receptor blockers to prevent thrombosis in VITT and other FcγRIIa-related inflammatory disorders."

Journal • Cardiovascular • Hematological Disorders • Inflammation • Thrombocytopenia • Thrombosis

Management of Heparin-Induced Thrombocytopenia: A Contemporary Review. (PubMed, J Clin Med) - "In comparison to parenteral options (e.g., bivalirudin and danaparoid), they are easier to administer, are more cost-effective, and obviate the need for transition to an oral anticoagulant after platelet recovery. We also identify the knowledge gaps and suggest areas for future research."

Journal • Review • Cardiovascular • Hematological Disorders • Thrombocytopenia • Thrombosis • Venous Thromboembolism

PLATELET INDEX CHANGES INDUCED BY CIRCULATING HISTONES: COMPARISON BETWEEN HEPARINS AS THERAPEUTIC APPROACH (ISLH 2024) - "Here we described the ability of two glycosaminoglycan-based heparins (Danaparoid and Fondaparinux) to counteract the effects of circulating free histones on platelets. Circulating free histones are critically involved in inflammatory monocyte activation and in concomitant significant thrombocytopenia (due to consumption/aggregation of platelets), as found in many diseases and viral/bacterial sepsis. The low molecular weight heparinoid Danaparoid revealed a potent activity as histone-neutralizing agent, mainly based on their charge interactions, opening future perspective for therapeutic options."

Cardiovascular • Hematological Disorders • Infectious Disease • Inflammation • Septic Shock • Thrombocytopenia • Thrombosis

UniXa: Multicentric Prospective Validation of a Universal Test to Quantify Apixaban, Rivaroxaban, Danaparoid and Fondaparinux Levels (clinicaltrials.gov) - P=N/A | N=2100 | Recruiting | Sponsor: Nantes University Hospital | Not yet recruiting ➔ Recruiting | Trial completion date: Jan 2023 ➔ May 2024 | Trial primary completion date: Jan 2023 ➔ May 2024

Enrollment open • Trial completion date • Trial primary completion date • Atrial Fibrillation • Cardiovascular • Venous Thromboembolism

AN UNUSUAL PRESENTATION OF HEPARIN INDUCED THROMBOCYTOPENIA (ACC 2024) - "While not a routine part of the workup for HIT, cardiac imaging can play a role in the detection of thrombus before a systemic embolic event, as in this case. High-risk populations, such as patients undergoing cardiac surgery, have up to a 5-fold risk of developing heparin-induced platelet antibodies and the clinical HIT syndrome. All heparin products should be immediately discontinued in patients with suspected or confirmed HIT."

Cardiovascular • Hematological Disorders • Thrombocytopenia • Thrombosis

A Case Report of Pulmonary Embolectomy Under Cardiopulmonary Bypass in a Patient with Intracranial Hemorrhage and History of Heparin-Induced Thrombocytopenia. (PubMed, A A Pract) - "We report the case of a patient with a history of heparin-induced thrombocytopenia who presented with a high-risk pulmonary embolism 10 days after the spontaneous onset of a voluminous intracerebral hematoma. Despite high doses of heparin required to run the cardiopulmonary bypass and subsequent anticoagulation by danaparoid sodium, the brain hematoma remained stable and the patient was discharged without complications 30 days after surgery."

Journal • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Hematological Disorders • Pulmonary Embolism • Respiratory Diseases • Thrombocytopenia

Short-Term and Long-Term Risk of Recurrent Vascular Event by Cause After Ischemic Stroke in Young Adults. (PubMed, JAMA Netw Open) - "Cause of ischemic stroke in young people is highly variable; however, the risk of recurrence is often presented with all subtypes of stroke grouped together in classification systems such as the Trial of ORG (danaparoid sodium [Orgaran]) 10172 in Acute Stroke Treatment (TOAST) criteria, which limits the ability to individually inform young patients with stroke about their risk of recurrence...The findings of this cohort study of 1216 patients with an ischemic stroke at a young age suggest that the risk of recurrent vascular events was high and varied by cause of stroke both for short-term and long-term follow-up, including causes that remained concealed when combined into 1 category in the routinely used TOAST criteria. This knowledge will allow for more personalized counseling of young patients with stroke."

Journal • Cardiovascular • Diabetes • Hypertension • Ischemic stroke • Metabolic Disorders • Myocardial Infarction

Immunologic Effects of Heparin Associated With Hemodialysis: Focus on Heparin-Induced Thrombocytopenia. (PubMed, Semin Nephrol) - "Management of HIT in HD usually requires use of an alternative (non-heparin) anticoagulant; for example, danaparoid sodium (outside the USA) or argatroban (USA and elsewhere). The HIT immune response is remarkably transient and usually not retriggered by subsequent heparin administration. Accordingly, since renal failure patients often require long-term HD, there may be the opportunity-following seroreversion (loss of platelet-activating HIT antibodies)-to restart heparin for HD, a practice that appears to have a low likelihood of retriggering HIT."

Journal • Review • Cardiovascular • Hematological Disorders • Ischemic stroke • Thrombocytopenia • Thrombosis

Anticoagulation for people receiving long-term haemodialysis. (PubMed, Cochrane Database Syst Rev) - "Anticoagulant strategies, including UFH and LMWH, have uncertain comparative risks on extracorporeal circuit thrombosis, while major bleeding and minor bleeding were not adequately reported. Regional citrate may decrease minor bleeding, but the effects on major bleeding and extracorporeal circuit thrombosis were not reported. Evidence supporting clinical decision-making for different forms of anticoagulant strategies for HD is of low and very low certainty, as available studies have not been designed to measure treatment effects on important clinical outcomes."

Journal • Review • Cardiovascular • Hematological Disorders • Myocardial Infarction • Thrombosis • Transplantation

An Updated Comprehensive Pharmacovigilance Study of Drug-Induced Thrombocytopenia based on FDA Adverse Event Reporting System Data. (PubMed, J Clin Pharmacol) - "The top five drugs by case number were lenalidomide (10601 cases), niraparib (3726 cases), ruxolitinib (3624 cases), eltrombopag (3483 cases) and heparin (3478 cases). The top five drugs by signal strength were danaparoid (ROR = 37.61, 95% CI 30.46-46.45), eptifibatide (ROR = 34.75, 95% CI 30.65-39.4), inotersen (ROR = 34.00, 95% CI 29.47-39.23), niraparib (ROR = 30.53, 95% CI 29.42-31.69) and heparin (ROR = 28.84, 95% CI 27.76-29.97)...The current comprehensive pharmacovigilance study identified more drugs associated with thrombocytopenia. While some drugs had been elucidated the mechanisms of DIT, others still required further investigation."

Adverse events • Journal • Hematological Disorders • Thrombocytopenia

Incidence and clinical outcomes of heparin-induced thrombocytopenia: 11 year experience in a tertiary care university hospital. (PubMed, Intern Emerg Med) - "If the latter was positive, any form of heparin was stopped, alternative anticoagulants were started and then overlapped with warfarin...All cause mortality was 25.5% (95% CI: 17.6-35.4), major bleeding 7.7% (95% CI:3.2-15.3), and thromboembolic complications 3.3% (95% CI:1.1-9.3). HIT is a rare event with high mortality, despite the use of non heparin anticoagulants."

Clinical data • Journal • Cardiovascular • Hematological Disorders • Thrombocytopenia • Thrombosis • Venous Thromboembolism

Ten questions related to heparin-induced thrombocytopenia (PubMed, G Ital Cardiol (Rome)) - "Argatroban and danaparoid are currently the only drugs approved for HIT treatment. Bivalirudin and fondaparinux are also used for the treatment of this rare but severe condition."

Journal • Cardiovascular • Hematological Disorders • Thrombocytopenia • Thrombosis

Quantitative Risk Evaluation of Adventitious Agents in Heparin. (PubMed, TH Open) - "Prion and viral safety cannot be assured by testing the active pharmaceutical ingredient itself; instead for the evaluation of the adventitious agent (i.e., viruses/prions) safety of heparin and heparinoid (e.g., Orgaran or Sulodexide) therapeutics, a risk assessment is required. The merits of this quantitative, worst-case approach are evaluated. The approach described in this review provides a tool for a quantitative risk evaluation of the viral and prion safety of heparin."

Journal • Review

Plasma Antithrombin III Levels Can Be a Prognostic Factor in Liver Cirrhosis Patients with Portal Vein Thrombosis. (PubMed, Int J Mol Sci) - "This retrospective study involved 75 patients with cirrhosis and PVT treated with danaparoid sodium with or without AT-III...Multivariate analyses indicated that low plasma AT-III levels (<54.0%) were an independent prognostic factor for poor survival outcome. Low plasma AT-III levels may be associated with mortality, particularly liver failure-related death, independent of liver function."

Biomarker • Journal • Cardiovascular • Fibrosis • Gastroenterology • Gastrointestinal Cancer • Hematological Disorders • Hepatocellular Cancer • Hepatology • Immunology • Liver Cirrhosis • Liver Failure • Oncology • Solid Tumor • Thrombosis • Venous Thromboembolism