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.
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);
- 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: Products containing benzyl alcohol should not 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:
- Neuroaxial spinal anesthesia or spinal puncture, especially if concurrent with an indwelling epidural catheter, drugs affecting hemostasis, history of traumatic/repeated spinal puncture, or spinal deformity (↑ risk of spinal hematoma);
- Severe uncontrolled hypertension;
- Bacterial endocarditis;
- Bleeding disorders;
- GI bleeding/ulceration/pathology;
- Hemorrhagic stroke;
- Recent CNS or ophthalmologic surgery;
- History of heparin-induced thrombocytopenia.
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 hr 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.
Renal Impairment
- SC (Adults ): CCr <30 mL/min: Monitor anti-Xa levels (target 0.5–1.5 IU/mL).
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 Gestational age ≥35 wk–<2 yr): 150 units/kg twice daily.
