Dalteparin sodium is a low molecular weight heparin (LMWH) derived from porcine intestinal mucosa. It acts as an anticoagulant by potentiating the inhibition of activated coagulation factor X (FXa) and thrombin (FIIa) via antithrombin III (ATIII). The 5000 IU strength is a standard prophylactic dose, widely used in the Indian healthcare setting for the prevention of venous thromboembolism (VTE) in high-risk surgical and medical patients. It offers predictable pharmacokinetics, allowing for once-daily subcutaneous administration without the need for routine coagulation monitoring (anti-Xa monitoring may be required in special populations).
Adult: **Prophylaxis (General Surgery/Medical):** 5000 IU SC once daily, starting 1-2 hours pre-op (surgical) or upon admission (medical), continued for 5-10 days or until patient is ambulant. **Prophylaxis (Orthopedic Surgery):** 5000 IU SC once daily, OR a higher dose regimen (e.g., 2500 IU pre-op, then 5000 IU once daily starting evening of surgery). **Treatment of DVT/PE:** 200 IU/kg body weight SC once daily (max 18,000 IU/day) OR 100 IU/kg SC twice daily. **ACS:** 120 IU/kg SC every 12 hours (max 10,000 IU per dose).
Note: For SUBCUTANEOUS USE ONLY. Do not administer intramuscularly or intravenously for prophylaxis/treatment. Inject deep subcutaneously into the abdominal wall, anterior thigh, or upper outer quadrant of buttock. Use a different site for each injection. Do not aspirate before injection. Do not massage the site. Pre-filled syringes are single-use. Patient must be lying down during administration.
Dalteparin exerts its anticoagulant effect by binding to and potentiating the natural inhibitor antithrombin III (ATIII). This binding causes a conformational change in ATIII, dramatically accelerating (by about 1000-fold) its ability to inactivate key coagulation enzymes, primarily Factor Xa and, to a lesser extent, Factor IIa (thrombin). The ratio of anti-Factor Xa to anti-Factor IIa activity for dalteparin is approximately 2.2:1.
Pregnancy: Category C. Does not cross the placental barrier in significant amounts. Considered the anticoagulant of choice for prophylaxis and treatment of VTE in pregnancy, especially in the 2nd and 3rd trimesters. Requires specialist management.
Driving: Dalteparin is unlikely to affect the ability to drive or operate machinery. However, dizziness has been reported rarely.
| Oral Anticoagulants (Warfarin, Acenocoumarol) | Increased risk of bleeding. Monitor INR closely during overlap therapy. | Major |
| Antiplatelet Drugs (Aspirin, Clopidogrel, NSAIDs like Diclofenac) | Potentiates antiplatelet effect, significantly increasing bleeding risk. | Major |
| Thrombolytics (Streptokinase, Alteplase) | Profound increase in bleeding risk. | Major |
| Other Heparins/LMWHs | Additive anticoagulant effect, avoid concurrent use. | Major |
| Herbal supplements (Ginkgo biloba, Garlic, Ginseng) | May increase bleeding risk. | Moderate |
| ACE Inhibitors (Ramipril, Enalapril) | Increased risk of hyperkalemia. | Moderate |