dalteparin
Brand: Fragmin
ISMP High Alert Prototype: enoxaparin
Drug Class: anticoagulant
Drug Family: anticoagulant
Subclass: low molecular weight heparin
Organ Systems: cardiovascularhematology-oncology
Mechanism of Action
LMWH; once-daily dosing for cancer-associated thrombosis; CLOT trial supported use over warfarin in cancer.
factor Xa via AT-III
Indications
- DVT/PE treatment (especially cancer-associated)
- thromboprophylaxis
- ACS
Contraindications
- active major bleeding
- HIT history
Adverse Effects
Common
- injection site bruising
- elevated LFTs
Serious
- major hemorrhage
- HIT
Pharmacokinetics (ADME)
| Absorption | 87% SC bioavailability |
| Distribution | moderate |
| Metabolism | reticuloendothelial |
| Excretion | renal |
| Half-life | 3-5 hours |
| Onset | 3-5 hours SC |
| Peak | 2-4 hours |
| Duration | 12-24 hours |
| Protein Binding | very low |
| Vd | 40-60 mL/kg |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| antiplatelet agents | increased bleeding | major |
Nursing Considerations
- CLOT trial: dalteparin superior to warfarin for cancer-associated DVT/PE
- Therapeutic: 200 IU/kg SC daily
- Anti-Xa monitoring in renal impairment or extreme body weights
Clinical Pearls
- CLOT trial: reduces recurrent VTE more than warfarin in cancer patients
- LMWH preferred over warfarin for cancer-associated thrombosis per ACCP/ASCO guidelines
Safety Profile
Pregnancy safe
Lactation use-with-caution
Renal Adjustment Required
Hepatic Adjustment Not required
TDM Not required
Guideline Update pending
Concordance Terms
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