Dalteparin Sodium

 Action Inhibits reactions that lead to clotting.

 Indications Prophylaxis of deep vein thrombosis (DVT), which may lead to pulmonary embolism, in patients undergoing hip replacement surgery or in patients undergoing abdominal surgery who are at risk for thromboembolic complications; prophylaxis of ischemic complications in unstable angina and non-Q-wave MI in patients on aspirin therapy.

 Contraindications Active major bleeding, thrombocytopenia, hypersensitivity to heparin or pork products.

 Route/Dosage

DVT Prophylaxis (Abdominal Surgery)

ADULTS: SC 2500 units starting 1 to 2 hrs before surgery and continuing QD for 5 to 10 days. Do not give IM.

DVT Prophylaxis (Hip Replacement Surgery)

ADULTS: SC If started postoperatively, 2500 units within 4 to 8 hr after surgery, followed by 5000 units/day for 5 to 10 days; if started preoperatively on day of surgery, 2500 units within 2 hr before surgery, followed by 2500 units 4 to 8 hr after surgery and continued at 5000 units/day for 5 to 10 days; if started preoperatively on the evening before surgery, 5000 units 10 to 14 hr before surgery, followed by 5000 units 4 to 8 hr after surgery and continued at 5000 units/day for 5 to 10 days.

Unstable Angina/Non-Q-Wave MI

ADULTS: SC 120 units/kg of body weight (max 10,000 units) q 12 hrs with aspirin (75 to 165 mg/day, unless contraindicated) therapy. Continue treatment until patient is clinically stabilized, usually 5 to 8 days.

 Interactions

Anticoagulants; platelet inhibitors: Increased risk of bleeding.

 Lab Test Interferences Aminotransferase (AST and ALT): Drug caused increased concentrations.

 Adverse Reactions

HEMA: Thrombocytopenia; hematoma; bleeding. HEPA: Serum transaminase elevation rarely associated with increased bilirubin. OTHER: Injection site pain/hematoma; allergic reactions (pruritus, rash, fever); skin necrosis; anaphylactoid reactions.

 Precautions

Pregnancy: Category B. Lactation: Undetermined. Children: Safety and efficacy not established. Thrombocytopenia: Use very cautiously in patients with history of heparin-induced thrombocytopenia. Units: Cannot be exchanged on a unit per unit basis with other types of heparin. Bleeding risk: Avoid use in patients at risk for bleeding (eg, severe hypertension, severe liver or kidney disease, platelet defects, etc.) or shortly after brain, spinal, or ophthalmological surgery. Benzyl alcohol: The multiple-dose vial of dalteparin contains benzyl alcohol as a preservative, which has been associated with fatal “gasping syndrome” in premature infants. Epidural/Spinal anesthesia: When neuraxial anesthesia or spinal puncture is employed, patients who are anticoagulated or scheduled to be anticoagulated with low molecular weight heparins are at risk of developing an epidural or spinal hematoma, which can result in long-term or permanent paralysis. Risk is increased by concurrent use of drugs affecting hemostasis (eg, NSAIDs, platelet inhibitors).

 Administration/Storage

• Do not mix with other injections or infusions until compatibility is determined.
• Do not administer by IM injection.
• Inspect all preparations for particulate matter prior to administration.
• Vary injection site daily.
• Store at room temperature.

 Assessment/Interventions

• Obtain patient history.
• Assess for signs of bleeding or bruising.
• Assess patient for signs of renal or hepatic insufficiency.
• During the course of treatment, monitor complete blood counts, including platelet count and stool occult blood tests.

 Patient/Family Education

• Instruct patient to report any signs of bleeding immediately.