Dose calculation tools are available for a range of body weights, specific clinical indications and lmwh products, and that consideration is given to rationalising the range of lmwh products used in. Evaluation of the pharmacokinetics of dalteparin in patients. What is the clinical evidence for the safety of tinzaparin versus dalteparin or enoxaparin. Fda box warning epidural or spinal hematomas may occur in patients who are anticoagulated with lowmolecularweight heparins or heparinoids and are receiving neuraxial anesthesia or undergoing spinal puncture. Aug 08, 20 whether a reduction in renal elimination will result in a clinically relevant accumulation of anticoagulant activity and an increased risk of bleeding after repeated dosing depends on several factors, including the severity of renal impairment, the dose administered, the duration of treatment and the dosing frequency. It also provides access to additional administration. Dalteparin may also be used for purposes not listed in this medication guide. Enoxaparin is low molecular weight heparin lmwh and was first approved for. Dalteparin sodium definition of dalteparin sodium by. Dalteparin sodium dosage guideline is intended to be a tool for healthcare professionals to determine the recommended dose of the medicine. Jun, 2018 to evaluate whether lmwh vte prophylaxis was safe and effective in critically ill patients with renal dysfunction, researchers conducted a subgroup analysis of protect, a randomised trial comparing dalteparin 5,000 iu daily with unfractionated heparin 5,000 iu twicedaily for vte prophylaxis. Dalteparin is a prescription medication used to prevent and treat blood clots. Anticoagulants in renal impairment bc renal agency.
Dalteparin mechanism, indication, contraindications, dosing. The renal drug handbook the st georges hospital, adult critical. Prescribing anticoagulants recommended prescribing options within hull and east riding, for patients requiring. Fragmin dalteparin dosing, indications, interactions, adverse. Jan 07, 2020 in patients with severely impaired renal function crcl dosing and only after the patient has received 34 doses. Adult drugs analgesics antihypertensive and cardiovascular agents antimicrobial agents miscellaneous agents sedatives, hypnotics, and other drugs used in. The therapeutic dose of dalteparin during pregnancy is based on maternal weight. Dalteparin dosing for cardiac events the standard dalteparin dosage after an episode of unstable angina a type of chest pain that may signal that a heart attack is near or a nonqwave myocardial infarction a type of mild heart attack is 120 iu per kg about 55 iu per pound every 12 hours, up to a maximum of 10,000 iu every 12 hours. Dalteparin is commonly used to prevent clotting in the dialysis system. Fragmin dalteparin dosing, indications, interactions.
Fragmin dalteparin sodium dose, indications, adverse. Dalteparin fragmin to prevent clotting during hemodialysis what is dalteparin. Access monograph information through desktop, laptop or mobile devices, with this new, easytouse, frequentlyupdated online platform. Monitor fbc, bcp and coagulation pt and aptt at baseline to check for contraindications to anticoagulation and that renal function are adequate.
The information contained in this book has been compiled. Dalteparin can accumulate in patients with gfr dalteparin is an lmwh 5000 mw with improved bioavailability, increased plasma elimination t2, and greater factor xa inhibitory activity compared with unfractionated heparin. Apr, 2020 while it is still important to routinely measure antixa activity in the obese patient, the practice of capping the dose of dalteparin in the obese patient cannot be justified, and obese patients. Vte in adults with dalteparin fragmin oxford university. Patients will be randomised to either tinzaparin or dalteparin to investigate the pharmacokinetics of both low molecular weight heparins lmwh perioperatively in a special population, namely end stage renal disease esrd dialysis patients. Dalteparin is a medication that is part of a group of drugs called blood thinners. Dalteparin can accumulate in patients with gfr dec 02, 2005 a prospective multicenter randomised trial involving 60 consecutive eligible and consenting patients from teaching hospitals in canada. Renal drug handbook 3rd edition general intensive care unit. 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 is a low molecular weight heparin lmwh similar to enoxaparin and tinzaparin. Nov 09, 2018 dalteparin is also used longterm to treat a type of blood clot called venous thromboembolism vte in people with cancer. Nov 27, 2019 detailed dalteparin dosage information for adults.
Antixa activity was determined before the first dalteparin dose and. As all patients receiving therapeutic doses of dalteparin at shmc are managed by the pharmacy department, there was no. This dosing regimen is borrowed from the recommended acute coronary syndrome acs treatment guide where a lower target aptt range of 1. The dosing of all lwmhs is based on the amount of inhibition of xa and iia and is commonly reported as the antixa. Fragmin dalteparin sodium dosage and administration. The information on dosage adjustments in renal impairment given in this book is. Deep vein thrombosis may lead to pulmonary embolism, a condition in. Children dalteparin may be used for the prevention and treatment of vte in children unlicensed use elderly dalteparin has been used safely in elderly patients without the need for dosage adjustment administration.
A prospective multicenter randomised trial involving 60 consecutive eligible and consenting patients from teaching hospitals in canada. Deep vein thrombosis is the formation of blood clots in veins deep in a muscle, most often in the legs. Pharmacy monitoring forms were used to identify patients and collect data. Dalteparin sodium is produced through controlled nitrous acid depolymerization of sodium heparin from porcine intestinal mucosa. Dalteparin potentiates preferentially the inhibition of coagulation factor xa and only slightly affects other hemostatic mechanisms such as clotting time. In a second randomized, controlled trial designed to evaluate longterm treatment with dalteparin days 6 to 45, data were also collected comparing 1week 5 to 8 days treatment of dalteparin 120 iukg every 12 hours s. Dosing is typically weightbased and renallyadjusted, and all prevention of venous thromboembolic disease in acutely ill hospitalized medical adults view in chinese trial protect of 3764 critically ill patients directly compared ufh to the lmw heparin, dalteparin. Action and clinical pharmacology mechanism of action.
Fragmin dalteparin sodium action and clinical pharmacology. The renal drug handbook is now available in database format. A comparison of dalteparin and tinzaparin for prevention. Dalteparin fragmin to prevent clotting during hemodialysis. Dalteparin is used to treat or prevent blood clots and their complications deep vein thrombosis or dvt and pulmonary embolism or pe. Treatment in extremes of body weight unlicensed consider using an increased treatment dose of dalteparin in patients weighing over 120kg only in those with a calculated egfr 30mlmin using the table below. Though equal in efficacy and amenable to oncedaily dosing for prophylaxis in the nonpregnant patient, they are more expensive than unfractionated heparin and have the same risks. Dalteparin sodium injection fragmin is a sterile, low molecular weight heparin lmwh, indicated for the prophylaxis of ischemic complications in unstable angina and nonqwave myocardial infarction, for the prophylaxis of deep vein thrombosis dvt, and for the extended treatment of symptomatic venous thromboembolism vte. Like other low molecular weight heparins, dalteparin is used for prophylaxis or treatment of deep vein thrombosis and pulmonary embolism.
Renal function should be assessed in all elderly patients 12. Vd for dalteparin antixa activity is 40 to 60 mlkg. Renal impairment vte in adult patients with cancer. Dalteparin given once or twice daily iv or sc is as effective as unfractionated heparin for the initial treatment of acute dvt. Its a selfinjectable solution that you or a caregiver administer by subcutaneous injection under your skin. Dalteparin is an anticoagulant that helps prevent the formation of blood clots. The bioavailability of a prophylactic dose of lmwhs ranges from 86% dalteparin to 98% enoxaparin, nadroparin. Fragmin must not be administered intramuscularly see warnings and precautions. Dalteparin dosing for preventing deep vein thrombosis dvt clots the standard dosage of dalteparin for preventing blood clots in people undergoing abdominal stomach surgery is 2500 iu once daily for 5 to 10 days, starting 1 to 2 hours before surgery.
Pediatric drugs analgesics antihypertensive and cardiovascular agents antimicrobial agents miscellaneous agents sedatives, hypnotics, and other drugs used in psychiatry. The primary route of elimination for dalteparin appears to be renal and is dose independent, unlike heparin, which has several saturable mechanisms of elimination. Medical information for dalteparin on pediatric oncall including mechanism. In patients with severely impaired renal function crcl dec, 2005 the present study aims to clarify the pharmacokinetics of dalteparin in patients with renal insufficiency, especially addressing the question of accumulation after multiple doses and including patients with severe renal insufficiency and derive a safe and suitable concept for using dalteparin in patients with impaired renal function. In patients with severely impaired renal function crcl webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. Compared with unfractionated heparin ufh, the drug has markedly improved bioavailability and increased plasma elimination halflife, and exerts a greater inhibitory effect on plasma activity of coagulation factor xa relative to its effects on other coagulation parameters. Patients were treated with dalteparin sodium subcutaneously twice daily for up to three months, with starting doses determined by age and. These blood clots can travel to the lungs and can become lodged in the blood vessels of the lungs, causing a condition called pulmonary embolism. Qa 238 3 lmwh in renal impairment treatment version 3 final. Pdf lifethreatening hemorrhage after dalteparin therapy in. This book is distributed under the terms of the creative commons. Why does someone on hemodialysis need this medication. Tinzaparin versus dalteparin or enoxaparin for the treatment.
Dalteparin dose recommendations for treatment of venous thromboembolism vte in patients with significant renal impairment crcl. Fragmin dalteparin side effects, images, uses, dosage. Dalteparin is a low molecular weight heparin lmwh with a mean molecular weight of 5000. Patients with renal disease have a higher risk of hemorrhage during anticoagulant therapy. Evaluation of the pharmacokinetics of dalteparin in patients with renal insufficiency article in international journal of clinical pharmacology and therapeutics 4410. A more conservative dose of 60 unitskg loading dose and 12 unitskgh maintenance dose is thus chosen for patients with severe kidney dysfunction. This dose minimization is still expected to achieve minimum therapeutic anticoagulation aptt 1. Fda approves dalteparin sodium for vte in pediatric patients fda. These hematomas may result in longterm or permanent paralysis. Dalteparin is used together with aspirin to prevent blood vessel complications in. Enoxaparin dose requires adjustment with a creatinine. Dalteparin is used to prevent deep venous thrombosis, a condition in which harmful blood clots form in the blood vessels of the legs.
Is dalteparin safe for patients with renal dysfunction. Dalteparin sodium an overview sciencedirect topics. Find dosing information about xarelto for initial deep vein thrombosis dvt and pulmonary embolism pe treatment. Includes dosages for myocardial infarction, angina pectoris, deep vein thrombosis prophylaxis.
Pdf safety of dalteparin for the prophylaxis of venous. Lifethreatening hemorrhage after dalteparin therapy in a patient with impaired renal function article pdf available in pharmacotherapy 256. Please see the attached document for dosing guidelines for lmwhs at uw medicine. Dalteparin side effects, dosage, interactions drugs. Jan 07, 2020 what should i avoid while using dalteparin fragmin. Dosage adjustment of medications eliminated by the kidneys. The renal function test should not delay initiation of the first dose but every effort must be made to base subsequent dosing on these results. Dalteparin the multicentre openlabel comparison of lowmolecular weight heparin versus oral anticoagulant therapy clot study compared dalteparin 200 ukg once daily for one month followed by 150 ukg. What is the clinical evidence for the safety of tinzaparin versus dalteparin or enoxaparin for the treatment of venous thromboembolism in adults with a glomerular filtration rate egfr less than 30 mlmin. Dalteparin is also sometimes used to help prevent strokes or blood clots in people who have atrial fibrillation or flutter a condition in which the heart beats irregularly, increasing the chance of clots forming in the body, and possibly causing strokes who are undergoing cardioversion a procedure to normalize the heart rhythm. In patients receiving dalteparin who experience platelet counts dalteparin until the platelet count recovers above 50,000mm3. Dose reductions for renal insufficiency in extended treatment of acute symptomatic venous thromboembolism in patients with cancer. Dosing differences and rationale among low molecular weight.
Find patient medical information for dalteparin porcine subcutaneous on webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. The manufacturer advises caution for the use of dalteparin in patients with severe renal disease or renal impairment. Monitor fbc, bcp and coagulation pt and aptt at baseline to check for contraindications to anticoagulation and that renal function is adequate. Renal failure in the case of significant renal failure, responsibility for treatment should lie with secondary care specialists.
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