Alternate Name(s):
FRAGMIN
Classification:
Antithrombotic-low molecular weight heparin
Original Date:
June 2008
Revised Date:
August 2008
Indications:
- 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
Compatibility:
-Solutions Compatible: 0.9% NaCl, D5W
-Additives/Above Cassette Compatible: no information
-Y-site Compatible: no information
-Incompatible: no information
Administration:
(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 |
| IM | NO |
| IV Push | NO |
| IV Intermittent Infusion | NO |
| IV Continuous Infusion | YES |
Dosage:
(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
Notes:
- 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
Antidote:
- Discontinue dalteparin
- 1 mg of protamine per 100 units of daltepain given in last dose (administer protamine IV over 10 minutes)