Dalteparin (Fragmin)

Indications

Multi-Center PROTECT Trial in Critically Ill Patients (NEJM, 2011) [MEDLINE]
- Dalteparin was not superior to unfractionated heparin prophylaxis in decreasing the incidence of Deep Venou sThrmbosis

Disorders
- Acute Pulmonary Embolism (PE) (see Acute Pulmonary Embolism)
- Deep Venous Thrombosis (DVT) (see Deep Venous Thrombosis)

PT/INR: no effect
- Dalteparin is an indirect thrombin inhibitor and should theoretically prolong the INR: however, most INR assay reagents contain heparin-binders which block the effect of heparin (or similar agents) at concentrations <1 unit/mL -> therefore, at heparin concentration of >1 unit/mL, the INR may be prolonged
PTT: no effect-prolonged
Anti-Factor Xa Activity (see Anti-Factor Xa Activity): prolonged

Adrenal Hemorrhage (see Adrenal Insufficiency)
Diffuse Alveolar Hemorrhage (DAH) (see Diffuse Alveolar Hemorrhage)
Epistaxis (see Epistaxis)
Gastrointestinal Hemorrhage (see Gastrointestinal Hemorrhage)
Intracerebral Hemorrhage (Hemorrhagic Cerebrovascular Accident) (see Intracerebral Hemorrhage)
Intracranial Epidural Hematoma (see Intracranial Epidural Hematoma)
Retroperitoneal Hemorrhage (see Retroperitoneal Hemorrhage)
Spinal Epidural Hematoma (see Spinal Epidural Hematoma)
Subarachnoid Hemorrhage (SAH) (see Subarachnoid Hemorrhage)
Subdural Hematoma (SDH) (see Subdural Hematoma)

Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med. 2003 Jul 10;349(2):146-53 [MEDLINE]
Management of venous thromboembolism in patients with advanced cancer: a systematic review and meta-analysis. Lancet Oncol. 2008 Jun;9(6):577-84. doi: 10.1016/S1470-2045(08)70149-9 [MEDLINE]
PROTECT Trial. Dalteparin versus unfractionated heparin in critically ill patients. N Engl J Med. 2011 Apr 7;364(14):1305-14. doi: 10.1056/NEJMoa1014475. Epub 2011 Mar 22 [MEDLINE]