Dalteparin (Fragmin)

Low molecular weight heparin

Only slightly affects the activated partial thromboplastin time (APTT).

Mean peak levels of plasma anti-FactorXa activity following single subcutaneous doses is attained in about 4 hours.

5,000 u subcutaneously daily for prophylaxis.

In doses up to 10,000 anti Factor Xa IU sc to healthy adults does not produce significant changes in platelet aggregation, fibrinolysis, prothrombin time, thrombin time or APTT and does not markedly affect platelet factor 4 (PF4) or lipoprotein lipase.

In patients with cancer and thromboembolism the risk of symptomatic recurrence is significantly lower with dalteparin compared to oral anticoagulant therapy (Lee et al.)

it has the highest level of evidence and is the only anticoagulant with FDA labeling for extended treatment of VTE to reduce recurrence risk in patients with cancer.

In unstable angina with EKG changes or non-Q-wave myocardial infarction patients randomized to 120 IU/kg every 12 hours subcutaneously or placebo every 12 hours, concurrently with aspirin and beta blockers, resulted in fewer myocardial infarctions and deaths.

In a trial of dalteparin vs unfractionated heparin randomly assigned in 3764 patients, and given subcutaneoulsy 5000 u daily or 5000 u bi, respectively in ICU patients: among critically ill patients dalteparin was not superior to unfractionated heparin in decreasing the incidence of proximal deep vein thrombosis (PROTECT Investigators).

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