Drug Information: Dalteparin
Detailed information regarding Dalteparin, a low molecular weight heparin (LMWH) commonly used in clinical settings. Dalteparin is a derivative of heparin that exhibits enhanced antithrombin activity. It is primarily used for the prevention and treatment of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE). Dalteparin offers a more predictable anticoagulant response compared to unfractionated heparin, allowing for subcutaneous administration and often eliminating the need for routine laboratory monitoring.
Category
Anticoagulant
Mechanism of Action
Dalteparin exerts its anticoagulant effect primarily by enhancing the activity of antithrombin III (ATIII), a naturally occurring plasma protein that inhibits several coagulation factors, most notably factor Xa and thrombin (factor IIa). Dalteparin binds to ATIII, causing a conformational change that significantly accelerates the rate at which ATIII inactivates these clotting factors. Unlike unfractionated heparin, Dalteparin has a greater affinity for factor Xa than for thrombin. This selective inhibition of factor Xa is attributed to its shorter chain length, making it less effective at simultaneously binding both ATIII and thrombin. By selectively inhibiting factor Xa, Dalteparin indirectly reduces the production of thrombin, thereby preventing the conversion of fibrinogen to fibrin, a critical step in clot formation. This ultimately prevents and treats thromboembolic events.
Clinical Uses
Dalteparin is indicated for a variety of clinical conditions involving the prevention and treatment of thromboembolic disorders. The primary clinical use is the prevention and treatment of venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE). It’s also used for prophylaxis of DVT in patients undergoing surgery, especially orthopedic surgery (e.g., hip or knee replacement) and abdominal surgery. Dalteparin is indicated in unstable angina and non-Q-wave myocardial infarction to prevent blood clots during acute coronary syndromes. Furthermore, it’s used to prevent clotting in extracorporeal circuits during hemodialysis. In pediatric patients, Dalteparin can be used to treat VTE although dosing must be tailored to achieve target anti-Xa levels.
Dosage
Dalteparin is administered via subcutaneous injection. Dosage varies depending on the indication.
* **Adults (VTE Treatment):** Typically, 200 IU/kg once daily or 100 IU/kg twice daily.
* **Adults (VTE Prophylaxis):** 2500 to 5000 IU once daily, depending on risk factors and type of surgery.
* **Pediatrics (VTE Treatment):** Weight-based dosing is used, often requiring monitoring of anti-Xa levels to achieve a therapeutic range (typically 0.5-1.0 IU/mL). A common starting dose is 100-150 IU/kg twice daily. Dosing adjustments are made based on Anti-Xa levels.
* **Renal Impairment:** Dosage adjustments may be necessary in patients with significant renal impairment.
It’s crucial to consult prescribing information and/or a healthcare professional for specific dosing guidelines based on individual patient factors and the specific indication.
Indications
Common indications for Dalteparin include:
* Treatment of acute deep vein thrombosis (DVT)
* Treatment of pulmonary embolism (PE)
* Prophylaxis of DVT in patients undergoing surgical procedures (e.g., orthopedic surgery, abdominal surgery)
* Prophylaxis of DVT in medical patients with restricted mobility
* Unstable angina and non-Q-wave myocardial infarction
* Prevention of clotting in extracorporeal circuits during hemodialysis
* Treatment of VTE in Pediatric population
Contraindications
Dalteparin is contraindicated in the following situations:
* Active major bleeding
* History of heparin-induced thrombocytopenia (HIT) or heparin-induced thrombocytopenia with thrombosis (HITTS)
* Hypersensitivity to dalteparin or other low molecular weight heparins
* Severe uncontrolled hypertension
* Recent major surgery involving the brain, spinal cord, or eye.
* Neuraxial anesthesia (epidural/spinal anesthesia) due to the risk of spinal hematoma
FAQ
**Q: What is Dalteparin used for?**
A: Dalteparin is used to prevent and treat blood clots, including deep vein thrombosis (DVT) and pulmonary embolism (PE).
**Q: How is Dalteparin administered?**
A: Dalteparin is given as a subcutaneous injection (under the skin).
**Q: What are the common side effects of Dalteparin?**
A: Common side effects include bleeding, bruising, pain or irritation at the injection site, and thrombocytopenia (low platelet count).
**Q: How is Dalteparin different from heparin?**
A: Dalteparin is a low molecular weight heparin (LMWH), while heparin is unfractionated. Dalteparin has a more predictable anticoagulant effect and usually doesn’t require routine lab monitoring as often as unfractionated heparin.
**Q: What should I do if I miss a dose of Dalteparin?**
A: If you miss a dose, take it as soon as you remember. However, if it’s almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not double the dose.
**Q: Can Dalteparin be used during pregnancy?**
A: Dalteparin may be used during pregnancy, but it should be used with caution and under the guidance of a healthcare professional. It does not cross the placenta.
**Q: What precautions should I take while on Dalteparin?**
A: Inform your doctor about all other medications you are taking, including over-the-counter drugs and herbal supplements. Be cautious with activities that could cause injury and increase the risk of bleeding.
**Q: How is Dalteparin monitored?**
A: Anti-Xa levels are monitored, particularly in pediatric patients and patients with renal insufficiency.
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