Dalteparina

Dalteparin, sold under brand names such as Fragmin, is a low molecular weight heparin (LMWH) anticoagulant derived from porcine mucosa. It exerts its anticoagulant effect mainly by binding to antithrombin III, which accelerates the inactivation of factor Xa; it has less activity against thrombin (factor IIa) compared with unfractionated heparin, giving a higher anti-Xa to anti-IIa activity ratio.

Administration is by subcutaneous injection. Dosing is weight-based and typically given once daily or twice daily, depending on the indication, with adjustments for renal function. Plasma anti-Xa activity is commonly used to monitor therapy in certain populations, such as those with renal impairment, extreme body weight, or pregnancy, but routine monitoring is not required for most patients.

Indications include prophylaxis of venous thromboembolism after major abdominal or orthopedic surgery; treatment of established DVT with or without pulmonary embolism; and, in some regimens, the management of certain acute coronary syndromes. It is derived from porcine sources, and patients with known pork allergy or sensitivity should avoid it.

Contraindications include active major bleeding, a history of heparin-induced thrombocytopenia, severe thrombocytopenia, and hypersensitivity to heparin. Caution is advised in patients with renal impairment, as the drug is cleared renally; prolonged use may be associated with osteoporosis and, rarely, HIT. Reversal of anticoagulation is partial with protamine sulfate.

Common adverse effects include bleeding, anemia, injection-site reactions, and thrombocytopenia. Dalteparin is generally stored at room temperature and protected from excessive heat and moisture.