Drug General Information (ID: DDI976RCQI)
Drug Name			Pegaspargase		Drug Info		Dalteparin		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antineoplastics				Anticoagulants
Structure

Mechanism of Pegaspargase-Dalteparin Interaction (Severity Level: Moderate)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Pegaspargase				Dalteparin
Mechanism		Risk of bleeding Anticoagulant effects				Risk of bleeding Anticoagulant
Key Mechanism Factor 1
		Factor Name		Bleeding
		Factor Description		Patients may be at risk for bleeding when the outcome of a disease or disease treatment confounds the standard mechanisms for maintaining hemostasis. Signs or symptoms of abnormal bleeding include: bleeding that takes a long time to stop (including nosebleeds, bleeding gums, bleeding from cuts and abrasions, and menstrual bleeding); severe unexplained bruising, or bruising that becomes larger; blood in the urine or stool, etc.
Mechanism Description		Increased risk of bleeding by the combination of Pegaspargase and Dalteparin

Recommended Action
Management		Coagulation parameters should be monitored at baseline and periodically during concomitant treatment with asparaginase and anticoagulants such as heparin, dipyridamole, aspirin and nonsteroidal anti-inflammatory drugs. Patients should be advised to promptly report any signs and symptoms of bleeding.

References
1	Caruso V, Iacoviello L, Di Castelnuovo A, et.al "Thrombotic complications in childhood acute lymphoblastic leukemia: a meta-analysis of 17 prospective studies comprising 1752 pediatric patients." Blood 108 (2006): 2216-22. [PMID: 16804111]
2	Cerner Multum, Inc. "Australian Product Information.".
3	Cerner Multum, Inc. "UK Summary of Product Characteristics.".
4	Duarte X, Esteves S, Neto AM, Pereira F "Incidence and risk factors for central nervous system thrombosis in paediatric acute lymphoblastic leukaemia during intensive asparaginase treatment: a single-centre study." Br J Haematol 174 (2016): 280-91. [PMID: 27018199]
5	Elice F, Rodeghiero F "Hematologic malignancies and thrombosis." Thromb Res 129 (2012): 360-6. [PMID: 22197450]
6	Grace RF, DeAngelo DJ, Stevenson KE, et.al "The use of prophylactic anticoagulation during induction and consolidation chemotherapy in adults with acute lymphoblastic leukemia." J Thromb Thrombolysis 45 (2018): 306-14. [PMID: 29260426]
7	Kieslich M, Porto L, Lanfermann H, Jacobi G, Schwabe D, Bohles H "Cerebrovascular complications of L-asparaginase in the therapy of acute lymphoblastic leukemia." J Pediatr Hematol Oncol 25 (2003): 484-7. [PMID: 12794528]
8	Product Information. Asparlas (calaspargase pegol). Servier, Boston, MA.
9	Product Information. Elspar (asparaginase). Merck & Co, Inc, West Point, PA.
10	Product Information. Erwinaze (asparaginase Erwinia chrysanthemi). EUSA Pharma, Newtown, PA.
11	Product Information. Oncaspar (pegaspargase). Rhone-Poulenc Rorer, Collegeville, PA.
12	Truelove E, Fielding AK, Hunt BJ "The coagulopathy and thrombotic risk associated with L-asparaginase treatment in adults with acute lymphoblastic leukaemia." Leukemia 27 (2013): 553-9. [PMID: 23099335]
13	Mitchell L, Andrew M, Hanna K, et.al "Trend to efficacy and safety using antithrombin concentrate in prevention of thrombosis in children receiving l-asparaginase for acute lymphoblastic leukemia. Results of the PAARKA study." Thromb Haemost 90 (2003): 235-44. [PMID: 12888870]