Dalteparin

Dalteparin
Names
Trade namesFragmin
Other namesDalteparin sodium
Clinical data
Drug classLow molecular weight heparin (LMWH)[1]
Main usesPrevent and treat blood clots[1]
Side effectsBleeding, low platelets, bruising at site of injection[1]
WHO AWaReUnlinkedWikibase error: ⧼unlinkedwikibase-error-statements-entity-not-set⧽
Pregnancy
category
  • AU: C[2]
  • US: N (Not classified yet)[2]
    Routes of
    use    		Subcutaneous
    External links
    AHFS/Drugs.comMonograph
    Legal
    Legal status
    • AU: S4 (Prescription only)
    • US: ℞-only
    Pharmacokinetics
    Bioavailability81-93%
    Elimination half-life3-5 hours subcutaneous; 2.1-2.3 hours IV
    ExcretionKidney

    Dalteparin, sold under the brand name Fragmin, is a medication used to treat and prevent deep vein thrombosis and pulmonary embolism.[1] It may also be used in heart attacks.[1] It is given by injection under the skin.[1]

    Common side effects include bleeding, low platelets, and bruising at the site of injection.[1] It may be used in pregnancy.[1] It is a low molecular weight heparin (LMWH).[1] It acts by binding to antithrombin III and inhibiting activation of Factor IX and thrombin.[3]

    Dalteparin was approved for medical use in the United States in 1994.[1] It is on the World Health Organization's List of Essential Medicines as an alternative to enoxaparin.[4] In the United Kingdom a dose of 5,000 units costs the NHS about £2.80 as of 2021.[5] In the United States this amount costs about 40 USD.[6]

    Medical uses

    The CLOT study, published in 2003, showed that in patients with malignancy and acute venous thromboembolism (VTE), dalteparin was more effective than warfarin in reducing the risk of recurrent embolic events.[7] Dalteparin is not superior to unfractionated heparin in preventing blood clots.[8]

    Dosage

    The dosage varies depending on the use and a persons weight.[5] This may vary from 5,000 to 18,000 units once per day.[5]

    Mechanism of action

    Heparins are cleared by the kidneys, but studies have shown that dalteparin does not accumulate even if kidney function is reduced.[9] Approximately 70% of dalteparin is excreted through kidneys based on animal studies.[10]

    History

    In May 2019, the U.S. Food and Drug Administration (FDA) approved dalteparin injection to reduce the recurrence of symptomatic VTE in children one month of age and older.[11]

    References

    1. 1 2 3 4 5 6 7 8 9 10 "Dalteparin Monograph for Professionals". Drugs.com. Archived from the original on 14 April 2021. Retrieved 17 December 2021.
    2. 1 2 "Dalteparin (Fragmin) Use During Pregnancy". Drugs.com. 27 November 2019. Archived from the original on 3 July 2020. Retrieved 1 June 2020.
    3. ↑ "Low Molecular Weight Heparins". LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. National Institute of Diabetes and Digestive and Kidney Diseases. 2012. Archived from the original on 6 May 2021. Retrieved 17 December 2021.
    4. ↑ World Health Organization (2023). The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023). Geneva: World Health Organization. hdl:10665/371090. WHO/MHP/HPS/EML/2023.02.
    5. 1 2 3 BNF 81: March-September 2021. BMJ Group and the Pharmaceutical Press. 2021. p. 144. ISBN 978-0857114105.
    6. ↑ "Fragmin Prices, Coupons & Savings Tips - GoodRx". GoodRx. Retrieved 17 December 2021.
    7. ↑ Lee AY, Levine MN, Baker RI, Bowden C, Kakkar AK, Prins M, Rickles FR, Julian JA, Haley S, Kovacs MJ, Gent M (2003). "Low-molecular-weight heparin versus a Coumadin for the prevention of recurrent venous thromboembolism in patients with cancer". N Engl J Med. 349 (2): 146–53. doi:10.1056/NEJMoa025313. PMID 12853587.
    8. ↑ The PROTECT Investigators for the Canadian Critical Care Trials Group and the Australian and New Zealand Intensive Care Society Clinical Trials Group (2011). "Dalteparin versus unfractionated heparin in critically ill patients". New England Journal of Medicine. 364 (14): 1305–1314. doi:10.1056/NEJMoa1014475. PMID 21417952.
    9. ↑ Douketis J, Cook D, Meade M, et al. (2008). "Prophylaxis against deep vein thrombosis in critically ill patients with severe renal insufficiency with the low-molecular-weight heparin dalteparin". Arch Intern Med. 168 (16): 1805–1812. doi:10.1001/archinte.168.16.1805. PMID 18779469.
    10. ↑ Pfizer Medication Information: Fragmin Pharmacokinetics | https://www.pfizermedicalinformation.ca/en-ca/fragmin/action-and-clinical-pharmacology# Archived 2021-05-07 at the Wayback Machine
    11. ↑ "FDA approves first anticoagulant (blood thinner) for pediatric patients to treat potentially life-threatening blood clots, PM FDA, May 16, 2019". U.S. Food and Drug Administration (FDA). Archived from the original on 14 September 2019. Retrieved 17 May 2019.
    Identifiers:
    • "Dalteparin sodium". Drug Information Portal. U.S. National Library of Medicine. Archived from the original on 2021-05-10. Retrieved 2021-06-15.
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