Dalteparin

DEA Class; Rx

Common Brand Names; Fragmin

• Anticoagulants, Cardiovascular; 
• Anticoagulants, Hematologic

Hypersensitivity to dalteparin, heparin or pork products

Active major bleeding, thrombocytopenia associated with antiplatelet antibodies

History of heparin-induced thrombocytopenia or heparin-induced thrombocytopenia with thrombosis

Patients undergoing epidural/neuraxial anesthesia, as a treatment for unstable angina and non-Q-wave MI or for prolonged VTE prophylaxis

Risk of epidural/spinal hematoma if used in patients getting epidural/spinal anesthesia which may result in paralysis

Periodic routine complete blood cell counts, including platelet count, blood chemistry, and stool occult blood tests are recommended during treatment

Use caution in patients with history of heparin-induced thrombocytopenia; heparin-induced thrombocytopenia can occur with administration of this drug; the incidence of this complication is unknown at present; in clinical practice, cases of thrombocytopenia with thrombosis, amputation and death have been observed; closely monitor thrombocytopenia of any degree

Do not give IM

Can’t be used interchangeably with other LMW heparins

Multidose vials contain benzyl alcohol as preservative (associated with potentially fatal “Gasping Syndrome” in preemies); when prescribing dalteparin multiple-dose vials in neonates and low-birth-weight infants, consider combined daily metabolic load of benzyl alcohol from all sources including multiple-dose vials (dalteparin contains 14 mg of benzyl alcohol per mL) and other drugs containing benzyl alcohol; minimum amount of benzyl alcohol at which serious adverse reactions may occur not known

If signs or symptoms of spinal hematoma are suspected, initiate urgent diagnosis and treatment including consideration for spinal cord decompression even though such treatment may not prevent or reverse neurological sequelae

Although specific recommendation for timing of a subsequent dose after catheter removal is unknown, consider delaying this next dose for at least four hours, based on a benefit-risk assessment considering both the risk for thrombosis and the risk for bleeding in the context of the procedure and patient risk factors

Available data have not reported a clear association with dalteparin and adverse developmental outcomes

There are risks to the mother associated with untreated VTE in pregnancy, and a potential for adverse effects on the preterm infant when used in pregnancy

Limited published data indicate that the drug is present in human milk in small amounts; no adverse effects on breastfed infant reported; there are no data on effects of drug on milk production; oral absorption of dalteparin is expected to be low, but clinical implications, if any, of this small amount of anticoagulant activity on a breastfed infant are unknown; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed child from the drug or from underlying maternal condition