Classification : Low molecular weight heparins ( Direct anticoagulant )

Dalteparin enhances the inhibition of coagulation factor Xa and thrombin ( factor IIa ). This is by binding to antithrombin III ( ATIII ). Thrombin production is decreased thus inhibiting fibrin clot formation[11]

Prevention & treatment of venous thromboembolism, prevent clotting during extracorporeal circulation ( haemodialysis & haemofiltration ).[6]

Prevention of deep vein thrombosis(DVT)[6]

Used in patient undergoing abdominal surgery in which the patient having risk for thromboembolic complication[6]

Used to prevent blood clot in haemodialysis or haemofiltration[8]

Management of unstable angina[8]

The main route of administration is deep subcutaneous (sc) injection. It must not be injected intramuscularly. [11]

For adults who has unstable angina or Non-Q-Wave MI, the dosage is subcutaneous 120 units/kg of body weight (max, 10,000 units) every 12 h with aspirin (75 to 165 mg/day, unless contraindicated) therapy. The treatment should be continued until the patient is clinically stabilized, usually from 5 to 8 days. [11]

Bleeding ( haemorrhage ), reduced with simultaneous IV injection of protamine sulphate[8,12]

Hepatic ( increase in liver enzymes ), pain at injection site[13]

i. Dalteparin- Platelet Inhibitors
Usage of dalteparin with use of platelet inhibitors and other anticoagulant increases risk of bleeding[4]

ii. Dalteparin-Iloprost
Usage of Dalteparin with iloprost increase anticoagulant effect . May lead to bleeding[4]

iii. Dalteparin – Clopidogrel
Clopidogrel when used with Dalteparin increase risk of bleeding[4]

iv. Dalteparin-Ketorolac
Frequent use of ketorolac with Dalteparin might cause haemorrhage[4]

Dose depends on uses

Eg.
For prevention of venous thromboembolism before surgery, dose 2500 units 1 or 2 hours before procedure by sc injection followed by 2500 units once daily for 5-7 days[8,12]

For unstable angina, it is given sc of 1.2mg/kg or 120units/kg for every 12 hours, continue to at least 5-8 days together with low dose aspirin[8]

This drug should not be administered intramuscularly. Patients with recent or anticipated epidural or spinal anesthesia are at risk of spinal & epidural hemitoma and consequent paralysis when using this drug[13]

Avoided in renal patient having creatine clearance less than 10mL/minute. Lead to increased of bleeding[1]

Caution in pregnancy and children use as the safety and efficacy of Daltepairn is yet to established[1]

Avoid use in patient having severe hypertension as Dalteparin increases risk of bleeding[1]

Avoid use in patient shortly after brain, spinal or opthalmological surgery[1]