Dalteparin dosing

Dose may depend on the lapsed time after LMWH administration (e.g., 0.5 mg protamine per 100 units dalteparin or tinzaparin to a maximum of 50 mg if >8 h has passed since the last administered dose)... 

Dalteparin 120 lU/kg SC every 12 hours (maximum single bolus dose of 10,000 units)... 

Benzyl alcohol The multiple-dose vials of dalteparin, enoxaparin, and tinzaparin contain benzyl alcohol as a preservative. Benzyl alcohol has been associated with a fatal gasping syndrome in premature infants. Because benzyl alcohol may cross the placenta, do not use LMWHs preserved with benzyl alcohol in pregnant women. Thromboembolic events If thromboembolic events occur despite LMWH prophylaxis, discontinue and initiate appropriate therapy. 

Prophylactic enoxaparin is given subcutaneously in a dosage of 30 mg twice daily or 40 mg once daily. Full-dose enoxaparin therapy is 1 mg/kg subcutaneously every 12 hours. This corresponds to a therapeutic anti-factor Xa level of 0.5—1 unit/mL. Selected patients may be treated with enoxaparin 1.5 mg/kg once a day, with a target anti-Xa level of 1.5 units/mL. The prophylactic dose of dalteparin is 5000 units subcutaneously once a day therapeutic dosing is 200 units/kg once a day for venous disease or 120 units/kg every 12 hours for acute coronary syndrome. The use of LMW heparins is discouraged or contraindicated in patients with renal insufficiency or body weight greater than 150 kg. 

Eriksson Bl, Arfwidsson AC, Frison L, et al. A dose-ranging study ofthe oral direct thrombin inhibitor, ximelagatran, and its subcutaneous form, melagatran, compared with dalteparin in the prophylaxis of thromboembolism after hip or knee replacement METHRO I, MEIagatran for THRombin inhibition in Orthopaedic surgery. Thromb Haemost 2002 87 231-237. 

Collignon R Frydman A, Caplain H, et al. Comparison of the pharmacokinetic profiles of three low-molecular mass heparins -dalteparin, enoxaparin and nadroparin administered subcutaneously in healthy volunteers (doses for prevention of thromboembolism). Thromb Haemost 1995 73 630-640. 

Dalteparin 2,500 units S.C. daily 5,000 units S.C. daily Unknown 100% 100% NA Check anti-factor Xa activity 4 hr after 2nd dose in patients with renal dysfunction NC NC NC... 

If major bleeding occurs in a patient receiving an LMWH, it is recommended that protamine sulfate be administered intravenously. However, because of its limited binding to the shorter LMWH chains, protamine sulfate cannot neutralize their anticoagulant effects completely. When given in equimolar concentrations, protamine sulfate neutralizes an estimated 60% to 75% of the antithrombotic activity. The recommended dose of protamine sulfate is 1 mg/1 mg of enoxaparin or 1 mg/100 anti-factor Xa units of dalteparin or tinzaparin administered in the previous 8 hours. If the LMWH dose was given in the previous 8 to 12 hours, a 0.5-mg dose of protamine should be given for every 100 anti-factor Xa units. The use of protamine sulfate is not recommended if the LMWH was administered more than 12 hours earlier. 

In two uncontrolled trials, patients tolerated the use of low-molecular-weight heparin well, and this approach showed a possible beneficial outcome. A randomized, double-blind study compared the efficacy of dalteparin with that of low-dose heparin. Dalteparm was more effective at improving bleeding symptoms, but there was no difference in mortality. ... 

Enoxaparin and other low molecular weight heparins fe.g.. ardeparin. dalteparin) produce a more predictable anticoagulant response than (unfractionated) heparin. This is a result of increased bioavailability, particularly after subcutaneous injection, longer half-life, and dose-independent clearance. 

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