NAME OF DRUG
dalteparin

CLASSIFICATION 
Anticoagulant, Low Molecular Weight Heparin

ALTERNATE NAMES
 FRAGMIN

INDICATIONS

• prevention and treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE)
• management of non-ST-elevation acute coronary syndromes (unstable angina and non-ST-elevation myocardial infarction)

PHARMACOLOGY

• dalteparin is a low molecular weight heparin obtained by depolymerization of conventional heparin
• compared to unfractionated (conventional) heparin, dalteparin is better absorbed after SC administration, has a longer duration of action, requires less laboratory monitoring and has a higher affinity for factor Xa.
  

RECONSTITUTION AND STABILITY

• stable at room temperature
  

COMPATIBILITY


ROUTES OF ADMINISTRATION

• SC injection
  • ideally to be administered in the anterolateral and posterolateral abdominal wall
  • do not expel air bubble out of the syringe to ensure patient receives complete dose

VH & HSC ADMINISTRATION POLICY

DOSAGE

Prevention of thromboembolism for orthopedic indications (total hip/knee replacement or revision, ortho trauma, spinal cord injury):

• 5000 IU SC daily

Prevention of thromboembolism in conjunction with general surgery:

•      Moderate Risk:   2500 IU SC daily

•      High Risk:           5000 IU SC daily

Management of Acute Coronary Syndromes (unstable angina and non-ST-elevation MI):

• 120 IU/kg SC q12h

• the manufacturer recommends a maximum dose of 10,000 IU/12 hours; however,  dosage should be individualized and higher dosages may be administered

Treatment of DVT/pulmonary embolism and non-ACS indications (e.g. atrial fibrillation)

• 200 IU/kg SC q24h

• the manufacturer recommends a maximum dose of 18,000 IU/24 hours; however, dosage should be individualized and higher dosages may be administered

• to adapt to single-dose prefilled syringes, the following weight intervals can be used:

• if switching from heparin infusion to dalteparin, discontinue heparin, then give first dose of dalteparin

POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION

• SC injection may cause hematoma, bruising and pain
• overdosage - hemorrhage (Antidote - protamine sulphate: each 1 mg of protamine neutralizes 100 IU dalteparin; do not exceed 50 mg protamine per dose)

IMPORTANT IMPLICATIONS 

• avoid intramuscular (IM) injections
• avoid non-steroidal anti-inflammatory drugs (NSAIDs), if possible
• side effects include bleeding complications, thrombocytopenia and transient elevations in liver enzymes
• hemoglobin and platelets should be monitored at least twice weekly during therapy
• dalteparin should not modify global clotting tests (i.e. aPTT, INR, thrombin time) 
• contraindicated if heparin allergy
• contraindicated in patients with active bleeding, blood dyscrasias, subacute bacterial   endocarditis, recent neurosurgical procedures 
• use with caution in patients with renal or hepatic dysfunction
• in patients with heparin-induced thrombocytopenia, dalteparin may exhibit cross-reactivity

VANCOUVER HOSPITAL AND HEALTH SCIENCES CENTRE 

Rev July 2005