Dalteparin

How it works

It potentiates antithrombin to inhibit factor Xa preferentially over thrombin, reducing fibrin clot formation while giving a more predictable anticoagulant response than unfractionated heparin.

Prescribing in practice

• It is renally cleared, so caution and consideration of anti-Xa monitoring apply in significant renal impairment where accumulation increases bleeding risk.
• Heparin-induced thrombocytopenia can occur, so platelets should be checked when treatment is prolonged and the drug stopped if it develops.
• Use with caution alongside other drugs affecting haemostasis and avoid in active major bleeding.

Monitoring

Routine monitoring is not usually needed, but check platelet count where treatment is extended and use anti-Xa activity to guide dosing in renal impairment, pregnancy or extremes of body weight.

Counselling the patient

• It is given as an injection under the skin; rotate injection sites.
• Report unusual bruising or bleeding.
• Do not stop suddenly without advice if treating a clot.

Evidence & guidelines

Trials including CLOT in cancer-associated thrombosis support dalteparin's efficacy and safety across venous thromboembolism and acute coronary indications.