Prophylaxis of clot formation in extracorporeal circulation during hemodialysis or hemofiltration, management of unstable angina, prevention of venous thromboembolism during surgical procedures, and treatment of venous thromboembolism.

Dalteparin Na is an antithrombotic agent that primarily enhances the inhibitory action of antithrombin on factor Xa and thrombin. It has a greater ability to inhibit factor Xa compared to its effect on prolonging APTT.

Intravenous:

• Prophylaxis of clotting in extracorporeal circulation during hemodialysis or hemofiltration: 30–40 U/kg IV injection, followed by 10–15 U/kg/hour as IV infusion.

Subcutaneous:

• Venous thromboembolism: 200 U/kg/day as a single dose or in two divided doses in pregnant and high-risk patients. Maximum: 18,000 U/day.
• Prophylaxis of venous thromboembolism during surgery: Moderate risk: 2,500 U 1–2 hours before surgery, then 2,500 U once daily for 5–7 days or until full ambulation. High risk: 2,500 U 1–2 hours before and 8–12 hours after surgery, then 5,000 U daily.
• Unstable angina: 120 U/kg every 12 hours for 5–8 days with low-dose aspirin. Maximum: 10,000 U every 12 hours.

There is an increased risk of bleeding when used with other anticoagulants or antiplatelet agents (e.g., aspirin, dipyridamole, glycoprotein IIb/IIIa receptor antagonists), vitamin K antagonists, NSAIDs, cytostatics, dextran, thrombolytics, sulfinpyrazone, probenecid, and etacrynic acid. The anticoagulant effect may be reduced when used with antihistamines, cardiac glycosides, tetracycline, and ascorbic acid.

Hypersensitivity, active major bleeding, severe coagulation disorders, lumbar puncture, sympathetic block, and recent or planned surgery involving the brain, spinal cord, eye, or ear, as well as severe hypertension.

Elevated liver enzymes (AST, ALT), allergic reactions (such as itching, rash, fever, injection site reactions, and bullous eruptions), pain at the injection site, epidural or spinal hematoma, which may lead to permanent paralysis, severe bleeding, and thrombocytopenia.

Pregnancy Category B. Animal studies have not shown fetal risk, but there are no adequate and well-controlled studies in pregnant women. In some cases, adverse effects observed in animal studies were not confirmed in human studies during the first trimester, and there is no evidence of risk in later trimesters.

Use with caution in patients at increased risk of bleeding (e.g., after surgery or trauma, hemorrhagic stroke, thrombocytopenia, platelet dysfunction, uncontrolled hypertension, hypertensive or diabetic retinopathy). There is an increased risk of spinal or epidural hematoma in patients undergoing neuraxial anesthesia or spinal puncture, especially with postoperative use of indwelling epidural catheters. Caution is also required in hepatic and renal impairment, and during pregnancy and lactation.

Symptoms: Hemorrhagic complications.
Management: Administer protamine sulfate by slow IV injection at a dose of 1 mg per 100 anti-Xa units of dalteparin sodium administered.

Parenteral anticoagulants (injectable blood thinners)

Store between 20–25°C.