Dalteparin

Mechanism :

Dalteparin is a low molecular weight heparin with antithrombotic properties. It acts by enhancing the inhibition of Factor Xa and thrombin by antithrombin while only slightly affecting clotting time, e.g., activated partial thromboplastin time (APTT). Dalteparin acts mainly by accelerating the rate of the neutralization of certain activated coagulation factors by ATIII but other mechanisms may also be involved. Dalteparin potentiates preferentially the inhibition of coagulation factor Xa and only slightly affects other hemostatic mechanisms such as clotting time.

Indication :

• Thrombo-prophylaxis in conjunction with surgery
• Treatment of acute deep venous thrombosis
• Unstable coronary artery disease
• Prevention of clotting in the extracorporeal system during hemodialysis and hemofiltration in connection with acute renal failure or chronic renal insufficiency.

Contraindications :

Dalteparin should not be administered IM. Hypersensitivity to dalteparin or other low molecular weight heparins and/or heparins; acute gastroduodenal ulcer and cerebral hemorrhage; septic endocarditis; injuries to and operations on the central nervous system, eyes and ears; uncontrollable active bleeding; major blood clotting disorders; severe untreated hypertension; diabetic or hemorrhagic retinopathy; other diseases involving an increased risk of hemorrhage; for the treatment of acute DVT and UCAD where repeated high dosages of dalteparin are required, spinal/epidural anesthesia is contraindicated due to an increased risk of bleeding.

Dosing :

Adverse Effect :

Injection site hematomas, unusual bleeding, osteopenic effect, transient slight to moderate elevation of liver transaminases, thrombocytopenia, anaphylactoid reactions, hyperkalemia.

Gasping syndrome occurred in premature neonates and low-birth weight infants who received benzyl alcohol preserved formulation. Additional adverse reactions seen are gradual neurological deterioration, seizures, intracranial hemorrhage, hematologic abnormalities, skin breakdown, hepatic and renal failure, hypotension, bradycardia, and cardiovascular collapse.

Interaction :

Liver Function Tests: As dalteparin can cause a rise in liver transaminases, this should be considered when liver function tests are assessed.
ASA, NSAIDs, Vitamin-K Antagonists and Dextran: Concomitant medication with effect on hemostasis, such as ASA, NSAIDs, vitamin-K antagonists and dextran may enhance the anticoagulant effect of dalteparin.

Renal Dose :

Hepatic Dose :