From the Guidelines
Dalteparin (Fragmin) is a type of Low Molecular Weight Heparin (LMWH) and is considered to be equivalent in efficacy and safety to other LMWHs, such as enoxaparin, in the prevention and treatment of venous thromboembolic disease, with the most recent evidence supporting its use in patients with cancer 1.
Key Points
- LMWHs, including dalteparin, work by inhibiting factor Xa and thrombin, with slightly different pharmacokinetic profiles compared to other anticoagulants.
- Dalteparin is typically dosed once daily, with advantages over unfractionated heparin including more predictable anticoagulant response, longer half-life, lower risk of heparin-induced thrombocytopenia, and less monitoring requirements.
- When choosing between different LMWHs, considerations include local formulary availability, cost, specific FDA-approved indications, and patient factors such as renal function, which may require dose adjustments.
- The most recent evidence from 2024 supports the use of dalteparin in patients with cancer, with a category 1 recommendation for DVT/PE treatment 1.
Comparison of LMWHs
- Dalteparin and enoxaparin have been compared in several studies, with no significant differences in bleeding, thrombocytopenia, or survival outcomes, but with a lower incidence of VTE in patients receiving LMWHs 1.
- Dalteparin has been found to be more effective than a coumarin derivative in preventing recurrent VTE, without increasing the risk of bleeding, in a large prospective randomized study 1.
- Enoxaparin has also been shown to be safe and effective in patients with cancer, but with limited evidence for long-term treatment and specific dosing recommendations for patients with severe renal insufficiency 1.
Patient Factors
- Renal function is an important consideration when choosing an LMWH, with specific dosing recommendations available for enoxaparin in patients with severe renal insufficiency (creatinine clearance <30 mL/min) 1.
- Monitoring of peak anti-Xa levels is recommended in patients with creatinine clearance <30 mL/min receiving dalteparin, although available data suggest it may be sufficiently cleared in patients with renal impairment 1.
- Body mass index is also a consideration, with a specific dosing recommendation available for enoxaparin in patients with a body mass index ≥40 kg/m2 1.
From the Research
Comparison of Low Molecular Weight Heparin (LMWH) and Dalteparin (Fragmin)
- LMWHs, including Dalteparin, are refined versions of heparin used as anticoagulant medications, developed in the 1980s 2
- Dalteparin is one of the eight chemically distinct and officially approved LMWHs, which are mainly used for preventing blood clots, treating deep vein thrombosis and pulmonary embolism, and treating myocardial infarction 2
- LMWHs have advantages over heparin, including good predictability, dose-dependent plasma levels, a long half-life, less bleeding, and a smaller risk of osteoporosis and heparin-induced thrombocytopenia and thrombosis 2, 3
- However, heparin is reversible with protamine sulfate, while LMWHs have no antidote, and LMWHs have less of an effect on inhibiting thrombin activity than heparin 2
- Dalteparin and other LMWHs are primarily cleared by the kidneys, and their use in patients with end-stage renal diseases may require caution, as they can accumulate and increase the risk of bleeding 4, 5
- Studies have compared the efficacy and safety of different LMWHs, including Dalteparin, for the treatment of deep vein thrombosis and pulmonary embolism, and found no significant differences between them 6
Key Differences and Similarities
- Dalteparin is a type of LMWH, and as such, it shares many characteristics and advantages with other LMWHs 2, 3
- The choice between Dalteparin and other LMWHs may depend on practical considerations, such as dosing and administration, rather than significant differences in efficacy or safety 6
- Patients with renal impairment or end-stage renal diseases may require careful consideration and monitoring when using Dalteparin or other LMWHs due to the risk of accumulation and bleeding 4, 5