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Dalteparin

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Dalteparin, Fragmin

  • See Also
  1. Low Molecular Weight Heparin (LMWH)
  2. Heparin
  3. Heparin Induced Thrombocytopenia
  4. Anticoagulation
  • Indications
  1. Venous Thromboembolism (DVT, PE) prophylaxis
  2. Venous Thromboembolism treatment (off-label)
  3. Acute Coronary Syndrome (off-label)
  • Mechanism
  1. See Low Molecular Weight Heparin (LMWH)
  1. Low risk
    1. Initial: 2500 IU SQ 1-2 hours before surgery
    2. Later: 2500 IU daily for 5-10 days
  2. High risk (e.g. hip surgery, Thrombophilia risk, pregnancy, medical patients with reduced mobility)
    1. Initial: 5000 IU SQ the evening before surgery or on medical admission
    2. Later: 5000 IU SQ daily for 5-10 days (up to 12 to 14 days for medical patients with restricted mobility patients)
  • Dosing
  • Adult Treatment
  1. VTE (DVT/PE) in active cancer (prolonged Anticoagulation)
    1. Initial first month: 200 units/kg SC daily
    2. Next 5 months: 150 units/kg SC daily
    3. Maximum: 18,000 units/day
  2. Venous Thromboembolism (DVT, PE) treatment (off-label)
    1. Dalteparin 200 units/kg SQ daily or 100 to 120 units/kg SC every 12 hours
  3. Unstable Angina
    1. Administer with Aspirin daily
    2. Dalteparin 120 units/kg (max 10,000 units) every 12 hours
  4. Renal impairement (GFR <30 ml/min)
    1. Target anti-Xa level 0.5 to 1.5 units/ml
    2. For 3 to 4 doses, recheck anti-Xa level 4 to 6 hours after dose
  • Dosing; Child (over age 4 weeks old)
  1. Venous Thromboembolism (DVT, PE) treatment
    1. Age 1 month to 2 years:
      1. Dalteparin 150 units/kg SQ every 12 hours
    2. Age 2 to 8 years
      1. Dalteparin 125 units/kg SQ every 12 hours
    3. Age 8 to 17 years
      1. Dalteparin 100 units/kg SQ every 12 hours
  • Safety
  1. Use in pregnancy when benefit outweighs the risk
  2. Considered safe in Lactation
  • Efficacy
  1. See Low Molecular Weight Heparin (LMWH)
  • Resources
  1. Dalteparin (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=23527b8b-9b28-4e6d-9751-33b143975ac7
  • References
  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  2. Miano (2018) Chest 153(1):133-42 +PMID: 28823757 [PubMed]
  3. Worley (2008) J Spinal Cord Med 31(4):379-87 +PMID: 18959355 [PubMed]