Dalteparin sodium

Dalteparin is a low molecular weight heparin. It is marketed as Fragmin. Like other low molecular weight heparins, dalteparin is used for prophylaxis or treatment of deep vein thrombosis and pulmonary embolism to reduce the risk of a stroke or heart attack.[2] Dalteparin acts by potentiating the activity of antithrombin III, inhibiting formation of both Factor Xa and thrombin.[3] It is normally administered by self-injection.

Dalteparin sodium
Clinical data
Trade namesFragmin
AHFS/Drugs.comMonograph
Pregnancy
category
Routes of
administration		Subcutaneous
ATC code
Legal status
Legal status
  • AU: S4 (Prescription only)
  • US: ℞-only
Pharmacokinetic data
Bioavailability81-93%
Elimination half-life3-5 hours subcutaneous; 2.1-2.3 hours IV
ExcretionKidney
Identifiers
CAS Number
DrugBank
ChemSpider
  • none
UNII
KEGG
ECHA InfoCard100.110.590

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.[4] Dalteparin is not superior to unfractionated heparin in preventing blood clots.[5]

Heparins are cleared by the kidneys, but studies have shown that dalteparin does not accumulate even if kidney function is reduced.[6] Approximately 70% of dalteparin is excreted through kidneys based on animal studies.[7]

In May 2019, the U.S. Food and Drug Administration (FDA) approved Fragmin injection to reduce the recurrence of symptomatic VTE in pediatric patients one month of age and older.[8] It is on the World Health Organization's List of Essential Medicines.[9]

References
  1. "Dalteparin (Fragmin) Use During Pregnancy". Drugs.com. 27 November 2019. Retrieved 1 June 2020.
  2. Dalteparin - Subcutaneous Injection, HealthLinkBC | https://www.healthlinkbc.ca/medications/fdb0271
  3. Pfizer Medical Information: Fragmin Pharmacodynamics | https://www.pfizermedicalinformation.ca/en-ca/fragmin/action-and-clinical-pharmacology#
  4. 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.
  5. 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.
  6. 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.
  7. Pfizer Medication Information: Fragmin Pharmacokinetics | https://www.pfizermedicalinformation.ca/en-ca/fragmin/action-and-clinical-pharmacology#
  8. "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). Retrieved 17 May 2019.
  9. World Health Organization (2021). World Health Organization model list of essential medicines: 22nd list (2021). Geneva: World Health Organization. hdl:10665/345533. WHO/MHP/HPS/EML/2021.02.
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