Parenteral Manual

Dalteparin (NON-FORMULARY)

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Antithrombotic-low molecular weight heparin
Original Date: 
June 2008
Revised Date: 
August 2008
  • Prophylaxis and treatment of thromboembolic disorders (deep vein thrombosis)
Reconstitution and Stability: 
  • Available as multiple dose vials containing 3.8 mL of 25,000 units/mL with benzyl alcochol as a preservative
  • Multi-dose vial stable 2 weeks at room temperature once punctured
  • Available as prefilled syringes (preservative free) containing 2500 units/0.2mL; 5000 units/0.2 mL; 7500 units/0.3 mL;10,000 units/0.4 mL; 12,500 units/0.5 mL; 15,000 units/0.6 mL; 18,000 units/0.72 mL

-Solutions Compatible:  0.9% NaCl, D5W

-Additives/Above Cassette Compatible:  no information

-Y-site Compatible:  no information

-Incompatible:  no information


(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC YES  -preferred                                                                                                                             Inject in the anterolateral or posterolateral abdominal girdle, alternate right and left sides.  DO NOT rub injection site after administration as bruising may occur
IV Push NO
IV Intermittent Infusion NO
IV Continuous Infusion YES




(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Adolescents & Adults:

- Treatment Dose for thromboembolic disorders

  • 200 units/kg subcutaneously once daily
  • 150 units/kg/day  subcutaneously for remainder of therapy  if treatment continues for >30 days 
  • 100 units/kg  subcutaneously twice daily if a high risk of bleeding
  • Round dose to nearest prefilled syringe size

- Prophylactic Dose:  varies depending on procedure

-Maximum Dose:  18,000 units daily


Potential hazards of parenteral administration: 
  • Bruising, hematemesis, nosebleed, melena, coffee ground emesis, hematuria, hemoptysis, thrombocytopenia
  • Leg pain, fever, hypotension, dizziness, vomiting, confusion, edema , dyspnea
  • Transient asymptomatic elevations of liver transaminases (AST, ALT);  reversible in 3-7 days after discontinuing the drug
  • Before initiation of treatment-  review patient's total drug regimen to prevent concomitant use of low molecular weight heparin and unfractionated heparin.
  • Hold for 12 hours prior to invasive procedures, eg. spinal puncture, and for 12 hours after the procedure  
  • Use with caution in patients with uncontrolled arterial hypertension, recent GI ulceration
  • Obtain CBC, PT, and APTT prior to initiation of dalteparin therapy
  • Monitor platelet counts daily, antifactor Xa (if initial measurement is therapeutic, monitor once weekly)
  • Elimination may be delayed in renal impairment - monitor antifactor Xa levels and watch for bleeding
  • Drug Interactions: anticoagulants, platelet inhibitors (aspirin, NSAIDS) may increase risk of bleeding

-Therapeutic antifactor Xa level  once patient has received 3-4 doses (measured 4 hours after SC administration)

  • Treatment dose: Target anti-Xa range:  1 - 2  international  units/mL  with once daily dosing


  • Discontinue dalteparin
  • 1 mg of protamine per 100 units of daltepain given in last dose (administer protamine IV over 10 minutes)

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