Dalteparin

From Drugs Prescribing Information
Jump to: navigation, search
Click on "►" to expand:

Contents

[edit] BRAND NAMES

[edit] MECHANISM OF ACTION

Dalteparin is a low molecular weight heparin (LMWH) with antithrombotic properties. LMWHs inhibit the coagulation process through binding to antithrombin (AT). This binding leads to a conformational change of AT which accelerates its inhibition of thrombin (factor IIa) and activated factor X (factor Xa).

In humans, dalteparin potentiates preferentially the inhibition of coagulation Factor Xa, while only slightly affecting the activated partial thromboplastin time (APTT). Factor Xa catalyzes the conversion of prothrombin to thrombin, so Dalteparin's inhibition of this process results in decreased thrombin and ultimately the prevention of fibrin clot formation.

LMWHs have a reduced potential to cause bleeding compared with unfractionated heparin (UFH).

[edit] INDICATIONS

  • Prophylaxis of deep vein thrombosis (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.
  • Extended treatment of symptomatic venous thromboembolism (VTE) to reduce the recurrence in patients with cancer. In these patients, the Dalteparin therapy begins with the initial VTE treatment and continues for six months. (Dalteparin is not indicated for the acute treatment of VTE)
  • Prophylaxis of ischemic complications of unstable angina and non-Q-wave myocardial infarction (NQWMI) when concurrently administered with aspirin therapy

[edit] DOSAGE

Indication Dosing Regimen
Unstable angina and non-Q-wave MI
120 IU/kg subcutaneous every 12
hours (with aspirin)
DVT prophylaxis in abdominal surgery
2500 IU subcutaneous once daily or
5000 IU subcutaneous once daily or
2500 IU subcutaneous followed by
2500 IU subcutaneous 12 hours later
and then 5000 IU subcutaneous once
daily
DVT prophylaxis in hip replacement
surgery
Postoperative start – 2500 IU subcutaneous 4 to 8 hours after surgery, then
5000 IU subcutaneous once daily or
Preoperative start – day of surgery
2500 IU subcutaneous 2 hours before
surgery followed by 2500 IU subcutaneous 4 to 8 hours after surgery, then
5000 IU subcutaneous once daily
Preoperative start – Evening Before Surgery
5000 IU subcutaneous followed by 5000 IU subcutaneous 4 to 8 hours after surgery
DVT prophylaxis in medical patients 5000 IU subcutaneous once daily
Extended treatment of VTE in patients
with cancer
Month 1: 200 IU/kg subcutaneous once daily 
Months 2-6: 150 IU/kg subcutaneous once daily 

Dalteparin should not be used as intramuscular injection.

[edit] CONTRAINDICATIONS

  • Active major bleeding
  • History of heparin induced thrombocytopenia or heparin induced thrombocytopenia with thrombosis
  • Hypersensitivity to dalteparin
  • In patients undergoing Epidural/Neuraxial anesthesia, Dalteparin should not be administered.
  • As a treatment for unstable angina and non-Q-wave MI
  • For prolonged VTE prophylaxis
  • Hypersensitivity to heparin or pork products

[edit] WARNINGS AND PRECAUTIONS

  • 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 nonsteroidal 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

Patients should be monitored frequently for signs and symptoms of neurological impairment. If neurological compromise is noted, urgent treatment is necessary. benefits and risks shoud be also considered before neuraxial intervention in patients anticoagulated or to be anticoagulated for thromboprophylaxis

  • Use caution in conditions with increased risk of hemorrhage
  • Monitor thrombocytopenia of any degree closely
  • Periodic blood counts recommended

[edit] INTERACTIONS

Use Dalteparin with care in patients receiving oral anticoagulants (Warfarin, aspirin), Platelet aggregation inhibitors , and thrombolytic agents (alteplase, reteplase, tenecteplase, anistreplase, streptokinase, urokinase)

[edit] PREGNANCY AND LACTATION

  • Pregnancy Category B (US)
  • Nursing Mothers: Based on limited published data dalteparin is minimally excreted in human milk. Caution should be exercised when Dalteparin is administered to a nursing woman.

[edit] SIDE EFFECTS

Most common adverse reaction is hematoma at the injection site

[edit] RELATED LINKS

[edit] BIBLIOGRAPHY

[edit] REFERENCES