• Prevention of deep vein thrombosis (DVT) in patients undergoing hip replacement surgery or abdominal surgery, or medical patients with restricted mobility.
• Extended treatment of symptomatic venous thromboembolism (VTE) (DVT and/or pulmonary embolism [PE]) in patients with cancer.
• Prevention of ischemic complications (with aspirin) in patients with unstable angina or non-ST-segment elevation MI
• Treatment of symptomatic VTE in pediatric patients.

Contraindicated in:

• Hypersensitivity to dalteparin, heparin, or pork products
• Active major bleeding
• Thrombocytopenia related to previous dalteparin therapy.

Use Cautiously in:

• Severe renal or hepatic impairment
• Retinopathy (hypertensive or diabetic)
• Spinal or epidural anesthesia
• OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk
• Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant
• Pedi: Children <1 mo (safety and effectiveness not established); products containing benzyl alcohol should be used in neonates or infants
• Geri: Risk of bleeding may be ↑ in older adults; consider age-related ↓ in renal function and body weight.

Exercise Extreme Caution in:

• Spinal/epidural anesthesia or spinal puncture (↑ risk of spinal/epidural hematoma that may lead to long-term or permanent paralysis)
• Severe uncontrolled hypertension
• Bacterial endocarditis
• Bleeding disorders
• GI bleeding/ulceration/pathology
• Hemorrhagic stroke
• Recent CNS or ophthalmologic surgery
• History of heparin-induced thrombocytopenia.

GI: reversible ↑ in liver enzymes.

Hemat: bleeding, thrombocytopenia.

Neuro: dizziness.

Drug-Drug:

• Risk of bleeding ↑ by concurrent use of thrombolytics, anticoagulants, or agents that affect platelet function including NSAIDs, clopidogrel, tirofiban, or eptifibatide.

• Solution for injection (prefilled syringes): 2500 units/0.2 mL; 3500 units/0.28 mL; 5000 units/0.2 mL; 7500 units/0.3 mL; 10,000 units/0.4 mL; 10,000 units/mL; 12,500 units/0.5 mL; 15,000 units/0.6 mL; 16,500 units/0.66 mL; 18,000 units/0.72 mL;
• Solution for injection (multidose vials): 25,000 units/mL;

DVT Prophylaxis

• SC (Adults): Abdominal surgery: 2500 units 1–2 hr before surgery, then once daily for 5–10 days; High-risk patients undergoing abdominal surgery: 5000 units evening before surgery, then once daily for 5–10 days or 2500 units 1–2 hr before surgery, another 2500 units 12 hour later, then 5000 units daily for 5–10 days; Hip replacement surgery: 2500 units within 2 hr before surgery, another 2500 units evening of the day of surgery 6 hr after first dose, then 5000 units daily for 5–10 days (if surgery is in the evening omit second dose day of surgery) or 5000 units evening before surgery, then 5000 units daily for 5–10 days.Medical patients with severely restricted mobility: 5000 units for 12 to 14 days.

Extended Treatment of Symptomatic VTE in Patients with Cancer

• SC (Adults): 200 units/kg once daily (not to exceed 18,000 units/day) for first 30 days, then 150 units/kg once daily (not to exceed 18,000 units/day) for mo 2–6.

Angina/Non ST-Segment-Elevation MI

• SC (Adults): 120 units/kg (not to exceed 10,000 units) every 12 hr with concurrent aspirin.

Treatment of Symptomatic VTE

• SC (Children 8–<17 yr): 100 units/kg twice daily.
• SC (Children 2–<8 yr): 125 units/kg twice daily.
• SC (Children 1 mo–<2 yr): 150 units/kg twice daily.

Fragmin

• Potentiates the inhibitory effect of antithrombin on Factor Xa and thrombin.

• Prevention of thrombus formation.
• Decreased incidence of death or recurrent MI.

Therapeutic Classification: anticoagulants

Pharmacologic Classification: antithrombotics, low molecular weight heparins

Absorption: Well absorbed (87%) after SUBQ administration.

Distribution: Unknown.

Metabolism/Excretion: Unknown.

Half-life: 2.1–2.3 hr.

(antithrombotic effect)

• Instruct patient in correct technique for injections, and care and disposal of equipment.
• Advise patient to report any symptoms of unusual bleeding or bruising, dizziness, itching, rash, fever, swelling, or difficulty breathing to health care professional immediately.
• Instruct patient not to take aspirin or NSAIDs without consulting health care professional while on dalteparin therapy.
• Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking any other Rx, OTC, or herbal products.
• Advise patient to notify health care professional of medication regimen prior to treatment or surgery.
• Advise patient to notify health care professional if pregnancy is planned or suspected or if breast feeding.

dal-TE-pa-rin