Drug General Information (ID: DDIUOV8HRS)
Drug Name			Indomethacin		Drug Info		Danaparoid		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antiinflammatory Agents				Anticoagulants

Mechanism of Indomethacin-Danaparoid Interaction (Severity Level: Major)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Indomethacin				Danaparoid
Mechanism		Risk of bleeding Antiplatelet 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 Indomethacin and Danaparoid

Recommended Action
Management		Products containing NSAIDs, especially if given chronically and in high dosages, should preferably be avoided in patients receiving LMWHs or heparinoids. Close clinical and laboratory observation for bleeding complications is recommended if concurrent therapy is necessary. In patients undergoing neuraxial intervention, coadministration of these agents should be approached with caution and only after thorough assessment of risks and benefits.

References
1	Bang CJ, Riedel B, Talstad I, Berstad A "Interaction between heparin and acetylsalicylic acid on gastric mucosal and skin bleeding in humans." Scand J Gastroenterol 27 (1992): 489-94. [PMID: 1321488]
2	Heiden D, Rodvien R, Mielke CH "Heparin bleeding, platelet dysfunction, and aspirin." JAMA 246 (1981): 330-1. [PMID: 7241778]
3	Klinkhardt U, Breddin HK, Esslinger HU, Haas S, Kalatzis A, Harder S "Interaction between the LMWH reviparin and aspirin in healthy volunteers." Br J Clin Pharmacol 49 (2000): 337-41. [PMID: 10759689]
4	Price AJ, Frcpath DO "Is there a clinical interaction between low molecular weight heparin and non-steroidal analgesics after total hip replacement?" Ann R Coll Surg Engl 77 (1995): 395. [PMID: 7486773]
5	Product Information. Fragmin (dalteparin). Pharmacia and Upjohn, Kalamazoo, MI.
6	Product Information. Innohep (tinzaparin) DuPont Pharmaceuticals, Wilmington, DE.
7	Product Information. Lovenox (enoxaparin). Rhone-Poulenc Rorer, Collegeville, PA.
8	Product Information. Normiflo (ardeparin). Wyeth-Ayerst Laboratories, Philadelphia, PA.
9	Product Information. Orgaran (danaparoid). Organon, West Orange, NJ.
10	Theroux P, Ouimet H, McCans J, et al. "Aspirin, heparin, or both to treat acute unstable angina." N Engl J Med 319 (1988): 1105-6. [PMID: 3050522]
11	Walker AM "Predictors of bleeding during heparin therapy." JAMA 244 (1980): 1209-12. [PMID: 7411781]
12	Weale AE, Warwick DJ, Durant N, Prothero D "Is there a clinical interaction between low molecular weight heparin and non-steroidal analgesics after total hip replacement?" Ann R Coll Surg Engl 77 (1995): 35-7. [PMID: 7717643]