What is the recommended dose of Fragmin (dalteparin) for DVT prophylaxis in a patient with normal kidney function?

From the Guidelines

The recommended dose of Fragmin (dalteparin) for DVT prophylaxis in patients with normal kidney function is 5,000 international units (IU) administered subcutaneously once daily. This dosing is based on the most recent and highest quality study available, which is the 2024 study from the Journal of the National Comprehensive Cancer Network 1. According to this study, dalteparin is recommended at a dose of 200 units/kg SC daily for 30 days, then switched to 150 units/kg once daily, but for DVT prophylaxis, the dose is 5,000 IU subcutaneously once daily.

Key Points

• The dose of 5,000 IU subcutaneously once daily is appropriate for most medical and surgical patients at risk for venous thromboembolism.
• No dose adjustment is needed for patients with normal kidney function, though monitoring anti-Xa levels is not routinely required.
• Dalteparin works by enhancing antithrombin's inhibition of Factor Xa and thrombin, preventing clot formation while having minimal impact on overall clotting parameters.
• Administration should occur at approximately the same time each day, and the injection should be given in the abdominal area, rotating injection sites.

Considerations

• For patients with renal insufficiency, caution should be used when administering LMWHs, and dose adjustments may be necessary, as seen in the 2011 study from the Journal of the National Comprehensive Cancer Network 1.
• The 2013 study from the Journal of Clinical Oncology 1 also supports the use of dalteparin for DVT prophylaxis, with a recommended dose of 5,000 U once daily.
• The 2013 study from the Journal of the National Comprehensive Cancer Network 1 provides additional guidance on the use of LMWHs for DVT prophylaxis, including dalteparin, and recommends a dose of 5,000 units subcutaneously daily.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Indication Dosing Regimen ... DVT prophylaxis in abdominal surgery 2,500 units subcutaneous once daily or 5,000 units subcutaneous once daily or 2,500 units subcutaneous followed by 2,500 units subcutaneous 12 hours later and then 5,000 units subcutaneous once daily (2. 2) ... DVT prophylaxis in medical patients 5,000 units subcutaneous once daily (2.2)

The recommended dose of Fragmin (dalteparin) for DVT prophylaxis in a patient with normal kidney function is:

• 5,000 units subcutaneous once daily for medical patients 2
• Alternatively, for abdominal surgery: 2,500 units subcutaneous once daily or 5,000 units subcutaneous once daily 2 Note that the dose may vary depending on the specific clinical context, such as the type of surgery.

From the Research

Fragmin (Dalteparin) Dosing for DVT Prophylaxis

• The recommended dose of Fragmin (dalteparin) for DVT prophylaxis in patients with normal kidney function is not explicitly stated in the provided studies.
• However, according to the study 3, dalteparin 2500U once daily subcutaneously is of similar antithrombotic efficacy to unfractionated heparin (UFH) 5000IU twice daily.
• Another study 4 mentions that high-risk patients received dalteparin 5,000 U subcutaneously once daily, and those with anti-Xa less than 0.1 IU/mL 12 hours after initial dalteparin dose received dalteparin every 12 hours.

Considerations for Patients with Normal Kidney Function

• The study 5 evaluates the pharmacokinetic data of dalteparin at a therapeutic dose in patients with renal insufficiency, but it does not provide specific dosing recommendations for patients with normal kidney function.
• The study 6 compares the efficacy and safety of dalteparin versus vitamin K antagonist (VKA) for prevention of recurrent VTE in patients with cancer and renal impairment, but it does not provide information on dosing for patients with normal kidney function.
• The study 7 assesses the safety and pharmacodynamics of dalteparin in critically ill patients with severe renal insufficiency, but it does not provide dosing recommendations for patients with normal kidney function.

Dosing Recommendations

• Based on the available information, the dosing of dalteparin for DVT prophylaxis in patients with normal kidney function may be similar to that used in the study 3, which is 2500U once daily subcutaneously.
• However, it is essential to consult the prescribing information and clinical guidelines for the most up-to-date and specific dosing recommendations for individual patients 3, 4.