Learn about other FRAGMIN indications throughout the hospital

  • Resource Center

    FRAGMIN Resource Center

    Eisai offers resources to assist you and your staff in the education and administration of FRAGMIN.

    Learn more >
  • Resource Center

    FRAGMIN Self-Injection Demo Video

    This Self-Injection Demo Video walks patients through the steps of injecting with a fixed-dose or graduated syringe.

    Learn more >
  • Resource Center

    FRAGMIN Patient Education and Administration Kits

    Educational materials, including an easy-to-understand reference chart, a step-by-step product brochure, and a how-to demonstration video, introduce patients to the use of FRAGMIN at home.

    Learn more >

Handling and Administration of FRAGMIN

  • Patients must be sitting or lying down
    —
    Administration must be by deep subcutaneous injection
    —
    FRAGMIN must not be administered by intramuscular injection
  • When the area around the navel or thigh is injected, using the thumb and forefinger, you must lift up a fold of skin while giving the injection
  • Use a 45- to 90-degree angle of insertion for the entire length of the needle

    Locations

  • Do not attempt to push syringe through plastic
  • Peel foil to remove syringe
  • While removing the syringe from the package, hold the syringe assembly by the open sides of the syringe, not the plunger or finger flange
  • Plunger should only be handled upon injection
  • Pull the needle shield straight off so needle does not bend
  • Keep the needle pointing up until ready to inject
  • Inspect the medicine to ensure it is clear and has nothing floating in it
When using prefilled fixed-dose syringes:
  • To ensure delivery of the full dose, the air bubble should not be expelled from the prefilled syringe before injection. 
  • Hold the syringe by the open sides of the device and remove the needle shield. 
  • Insert the needle into the injection area as described previously. 
  • Depress the plunger of the syringe while holding the finger flange until the entire dose has been given.
  • The needle guard will not be activated unless the entire dose has been given. 
  • Next, remove the needle from the body. Let go of the plunger and allow the syringe to move up inside the device until the entire needle is guarded. 
  • The syringe assembly should be discarded in approved containers. 

Single Dose

When using graduated syringes:

  • Hold the syringe by the open sides of the device and remove the needle shield.
  • With the needle pointing up, prepare the syringe by expelling the air bubble and then continuing to push the plunger to the desired dose or volume, discarding the extra solution in an appropriate manner.
  • Insert the needle into the injection area as described previously.
  • Depress the plunger of the syringe while holding the finger flange until the entire dose remaining in the syringe has been given.
  • The needle guard will not be activated unless the entire dose has been given.
  • Next, remove the needle from the body. Let go of the plunger and allow the syringe to move up inside the device until the entire needle is guarded.
  • The syringe assembly should be discarded in approved containers.

Please note: When using multiple-dose vials, after the first penetration of the rubber stopper, the multiple-dose vials should be stored at room temperature for up to 2 weeks. Discard any unused solution after 2 weeks.

Graduated Dose

IMPORTANT SAFETY INFORMATION

WARNING: SPINAL/EPIDURAL HEMATOMA

Epidural or spinal hematomas may occur in patients who are anticoagulated with low molecular weight heparins (LMWH) or heparinoids and are receiving neuraxial anesthesia or undergoing spinal puncture. These hematomas may result in long-term or permanent paralysis. Consider these risks when scheduling patients for spinal procedures. Factors that can increase the risk of developing epidural or spinal hematomas in these patients include:

  • Use of indwelling epidural catheters
  • Concomitant use of other drugs that affect hemostasis, such as non-steroidal anti-inflammatory drugs (NSAIDs), platelet inhibitors, other anticoagulants
  • A history of traumatic or repeated epidural or spinal punctures
  • A history of spinal deformity or spinal surgery

Monitor patients frequently for signs and symptoms of neurological impairment. If neurological compromise is noted, urgent treatment is necessary.

Consider the benefits and risks before neuraxial intervention in patients anticoagulated or to be anticoagulated for thromboprophylaxis.

  • FRAGMIN is contraindicated in patients with active major bleeding, history of heparin induced thrombocytopenia, hypersensitivity to dalteparin sodium, heparin, or pork products.
  • FRAGMIN is contraindicated in patients undergoing epidural/neuraxial anesthesia as a treatment for unstable angina and non-Q-wave MI and for prolonged VTE prophylaxis due to an increased risk of bleeding associated with the dosage of FRAGMIN recommended for these indications.
  • FRAGMIN, like other anticoagulants, should be used with extreme caution in patients who have an increased risk of hemorrhage; bleeding can occur at any site during therapy. An unexpected drop in hematocrit or blood pressure should lead to a search for a bleeding site.
  • FRAGMIN should be used with caution in patients with bleeding diathesis, thrombocytopenia or platelet defects, severe liver or kidney insufficiency, hypertensive or diabetic retinopathy, and recent gastrointestinal bleeding.
  • FRAGMIN should be used with extreme caution in patients with history of heparin-induced thrombocytopenia.
    —
    In FRAGMIN clinical trials supporting non-cancer indications, platelet count of <50,000/mm3 occurred in <1% of patients.
    —
    In FRAGMIN clinical trials supporting the extended treatment of symptomatic VTE in patients with cancer, platelet counts of <100,000/mm3 occurred in 13.6% of patients, including 6.5% who also had platelet counts less than 50,000/mm3. In the same clinical trial, thrombocytopenia was reported as an adverse event in 10.9% of patients in the FRAGMIN arm and 8.1% of patients in the oral anticoagulant arm. FRAGMIN dose was decreased or interrupted in patients whose platelet counts fell below 100,000/mm3.
  • Thrombocytopenia of any degree should be monitored closely. Heparin-induced thrombocytopenia can occur with administration of FRAGMIN. The incidence of this complication is unknown at present. In clinical practice, rare cases of thrombocytopenia with thrombosis have also been observed.
  • Each multiple-dose vial of FRAGMIN contains benzyl alcohol as a preservative. Benzyl alcohol has been reported to be associated with a fatal “Gasping Syndrome” in premature infants. Because benzyl alcohol may cross the placenta, use caution when administering FRAGMIN preserved with benzyl alcohol to pregnant women. If anticoagulation with FRAGMIN is needed during pregnancy, use preservative-free formulations, where possible.
  • Periodic routine complete blood counts, including platelet count, blood chemistry, and stool occult blood tests are recommended during the course of treatment with FRAGMIN.
  • The most commonly reported side effect is hematoma at the injection site.
  • Allergic reactions (i.e., pruritus, rash, fever, injection site reaction, bulleous eruption) have occurred. A few cases of anaphylactoid reactions have been reported.
  • Use FRAGMIN with care in patients receiving oral anticoagulants, platelet inhibitors, and thrombolytic agents because of increased risk of bleeding.
  • FRAGMIN cannot be used interchangeably (unit for unit) with unfractionated heparin or other low molecular weight heparins.
  • FRAGMIN® Injection is not intended for intramuscular administration.
  • For more information about FRAGMIN please see Full Prescribing Information

INDICATIONS

When patients are at risk for thrombotic complications1

Prophylaxis of DVT

  • Medical
    • For patients who are at risk for thromboembolic complications due to severely restricted mobility during acute illness
  • Orthopedics
    • In patients undergoing hip replacement surgery
  • Surgery
    • In patients undergoing abdominal surgery who are at risk for thromboembolic complications

Treatment of symptomatic VTE

  • Oncology
    • Extended treatment of symptomatic VTE to reduce the recurrence of VTE in patients with cancer. In these patients, the FRAGMIN therapy begins with the initial VTE treatment and continues for 6 months
    • FRAGMIN is not indicated for the acute treatment of VTE

Prophylaxis of ischemic complications

  • Cardiology
    • Prophylaxis of ischemic complications in unstable angina (UA) and non–Q-wave myocardial infarction (NQWMI) when concurrently administered with aspirin therapy

Reference: 1. FRAGMIN prescribing information. Eisai Inc.; 2010.