Orgaran should not be used if an in vitro test for the heparin-induced antibody in the presence of Orgaran is positive in patients with thrombocytopenia induced by heparin or heparin-like anticoagulants, unless no suitable alternative antithrombotic treatment is available.
The incidence of serological cross-reactivity of Orgaran with the heparin-induced antibody before the start of therapy is approximately 5%. The incidence of clinical cross-reactivity developing during Orgaran therapy is approximately 3% and many of these patients had a negative pre-treatment serological cross-reactivity test. Although the risk of antibody-induced thrombocytopenia and thrombosis during Orgaran therapy (i.e. clinical cross-reactivity) is very small, it is advisable to check the number of platelets daily during the first week of treatment, on alternate days during the second and third weeks, and weekly to monthly thereafter. If a pre-treatment cross-reactivity test with Orgaran is positive but it is decided to use Orgaran, then the number of platelets should be checked daily until Orgaran treatment is stopped. If antibody-induced thrombocytopenia occurs, one should stop the use of Orgaran and consider alternative treatment.
Orgaran should not be administered to patients with severe hemorrhagic diathesis, e.g. hemophilia and idiopathic thrombocytopenic purpura, unless the patient also has HIT and no suitable alternative antithrombotic treatment is available.
Orgaran should not be used in patients with severe renal and hepatic insufficiency unless the patient also has HIT and no alternative antithrombotic treatment is available.
Orgaran should be used with caution in patients with moderately impaired renal, and/or liver function with impaired haemostasis, ulcerative lesions of the gastro-intestinal tract or other diseases which may lead to an increased danger of haemorrhage into a vital organ or site.
Orgaran should not be administered to patients with active gastric or duodenal ulceration, unless it is the reason for operation.
In clinical studies no clinically significant interactions with other medications have been found. Orgaran may be used together with oral anticoagulants, drugs which interfere with platelet function (such as aspirin and non-steroidal anti-inflammatory drugs) or potentially ulcerogenic drugs (such as corticosteroids), but caution remains necessary this is particularly important in patients undergoing peridural or spinal anaesthesia or spinal puncture (see section 4.4.). Monitoring of anticoagulant activity of oral anticoagulants by prothrombin time and thrombotest is unreliable within 5 hours after Orgaran administration.
There is no data available on the effect of Orgaran on thyroid function tests.
Interaction studies have only been performed in adults.
Orgaran has been used in over 60 pregnancies (starting during the first trimester in almost 50% of the pregnancies, the second trimester in approximately 20% of the pregnancies and the third trimester in 25% of the pregnancies. For a small number of patients the starting trimester is unknown). Overall, the use of Orgaran was successful.
Animal studies have not demonstrated any teratogenic effect or placental transfer. In the few cases in which human umbilical cord blood was tested for the presence of anti-Xa activity, no activity was found.
Although Orgaran has been used with success in a small number of pregnancies, the available information is still considered to be insufficient to assess whether deleterious effects may occur in pregnancy during the use of Orgaran.
Caution should be exercised when prescribing to pregnant women. If alternative antithrombotic treatment is unacceptable for medical reasons (e.g. HIT patients) Orgaran can be used.
In five cases in which breast milk samples were tested for anti-Xa activity, all showed no or negligible amounts of anti-Xa activity (which would be hydrolyzed in the infant’s stomach and rendered harmless).
Although the data are limited, if alternative antithrombotic treatment is unacceptable for medical reasons (e.g. HIT patients) Orgaran can be used during lactation.
Orgaran is not known to have any effect on the ability to drive and use machines.
Enhanced bleeding or haematoma may occur at the operation site.
Bruising and/or pain may occur at injection sites.
Within each frequency grouping, undesirable effects are presented in order of decreasing seriousness.
Common (≥1/100 to 1/10 of patients)
Uncommon (≥1/1,000 to 1/100 of patients)
Rare (≥1/10,000 to <1/1,000 of patients)
Common: thrombocytopenia*, heparin-induced thrombocytopenia
Rare: auto-immune thrombocytopenia
Uncommon: hypersensitivity, drug hypersensitivity
Uncommon: purpura, rash maculo-papular, rash erythematous, pruritus, urticaria
Rare: rash generalised, rash maculovesicular, injection or infusion site rash, rash macular
Uncommon: Injection site reaction
injection (inj.) site:
inj. or infusion site:
Common: post procedural hemorrhage
Uncommon: post procedural hematoma, operative hemorrhage
Rare: incision site hemorrhage, anastomotic hemorrhage
Note: terms are coded with MedDRA dictionary version 8.1
Antibody induced thrombocytopenia, as can be caused by (low molecular weight) heparin, was observed in rare cases during the use of Orgaran, but only in patients who were already sensitised to either heparin or low molecular weight heparin (see section 4.4).
All above terms in this section and synonym terms (with same or less severity) coded with the MedDRA dictionary are considered as ‘listed’.
All hemorrhages are listed adverse events for Orgaran. This also means that symptoms or signs which are clearly directly related to a hemorrhage (e.g. anaemia, decreased Hb, rbc, hematocrit, faintness, tiredness, tamponade) are listed adverse events.
Liver abnormalities such as changes in transaminase and alkaline phosphatase have been observed, but no clinical significance has been demonstrated.
Very rarely, cases of epidural and spinal haematomas were reported in association with prophylactic use of heparins in the context of peridural or spinal anaesthesia and of spinal puncture. These haematomas have caused various degrees of neurological impairment, including prolonged or permanent paralysis (see Section 4.4 ‘Special warnings and precautions for use’).
When administered as an intravenous bolus or infusion, Orgaran should be given separately and not mixed with other drugs. However, Orgaran is compatible with, and therefore can be added to, infusions of saline, dextrose or dextrose-saline.