What is the therapeutic dosing for Dalteparin (Fragmin)?

From the Guidelines

Fragmin (dalteparin) therapeutic dosing is typically 200 units/kg once daily subcutaneously for treatment of venous thromboembolism, with a maximum daily dose of 18,000 units, as recommended by the most recent guidelines 1. The dosing regimen for Fragmin can vary depending on the patient's condition, such as cancer-associated thrombosis, where the recommended regimen is 200 units/kg daily for the first month, followed by 150 units/kg daily for months 2-6 1. Some key points to consider when administering Fragmin include:

• Rotating injection sites between the left and right anterolateral and posterolateral abdominal wall, and avoiding the 2-inch area around the navel
• Monitoring platelet counts regularly during therapy due to the risk of heparin-induced thrombocytopenia
• Checking anti-Xa levels in special populations (renal impairment, pregnancy, extremes of weight) with target peak levels of 0.5-1.5 IU/mL for once-daily dosing
• Adjusting weight-based dosing throughout pregnancy as weight changes
• Considering dose reduction and anti-Xa monitoring in patients with renal impairment (creatinine clearance <30 mL/min) 1. Fragmin works by binding to antithrombin, enhancing its inhibitory effect on coagulation factors Xa and IIa, thereby preventing clot formation and extension while allowing the body's natural fibrinolytic processes to dissolve existing clots. It's worth noting that the guidelines for Fragmin dosing have been updated over time, with the most recent recommendations provided in the 2024 guidelines 1, which supersede earlier guidelines from 2020 1 and 2013 1.

From the FDA Drug Label

In patients with severely impaired renal function (CrCl <30 mL/min), monitor anti-Xa levels to determine the appropriate FRAGMIN dose. Target anti-Xa range is 0.5 units/mL to 1.5 units/mL. Patients were randomized to either FRAGMIN 200 units/kg subcutaneous (max 18,000 units subcutaneous daily for one month) then 150 units/kg subcutaneous (max 18,000 units) subcutaneous daily for five months

The therapeutic dosing of Fragmin (dalteparin) is as follows:

• For patients with severely impaired renal function, the dose should be adjusted based on anti-Xa levels, with a target range of 0.5-1.5 units/mL.
• For other patients, the dose is typically 200 units/kg subcutaneously (max 18,000 units) daily for the first month, followed by 150 units/kg subcutaneously (max 18,000 units) daily for five months 2, 2. Key considerations:
• The dose may need to be adjusted based on renal function and anti-Xa levels.
• The maximum daily dose is 18,000 units.
• The dose should be administered subcutaneously, not intramuscularly. Important notes:
• The dose may vary depending on the specific patient population and clinical context.
• It is essential to monitor anti-Xa levels and adjust the dose accordingly in patients with severely impaired renal function.

From the Research

Therapeutic Fragmin Dosing

• The dosing of dalteparin, also known as fragmin, for therapeutic purposes has been studied in various clinical settings 3, 4, 5, 6, 7.
• A study published in 2014 found that high-risk trauma patients receiving dalteparin 5,000 U subcutaneously once daily had lower rates of venous thromboembolism (VTE) when their anti-Xa concentrations were monitored and their dalteparin dose was adjusted accordingly 3.
• Another study published in 2006 found that dalteparin 5,000 IU subcutaneously once daily was safe and effective for VTE prophylaxis in elderly medical patients with renal insufficiency, with no evidence of bioaccumulation or major bleeding 4.
• A 2025 study compared the effectiveness of anti-Xa-guided enoxaparin thromboprophylaxis with fixed-dose dalteparin in trauma patients admitted to intensive care, and found that the anti-Xa-guided approach was associated with lower rates of VTE without increasing the risk of bleeding 5.
• The pharmacokinetics of dalteparin have been evaluated in patients with renal insufficiency, and found to be affected by renal function, with decreased anti-Xa clearance and increased free tissue factor pathway inhibitor (TFPI) levels 6.
• A 2024 study compared the real-world effectiveness of dalteparin and enoxaparin for VTE prophylaxis, and found that the incidence of VTE events was similar between the two groups, suggesting that dalteparin may be a suitable alternative to enoxaparin for VTE prophylaxis 7.

Key Findings

• Monitoring anti-Xa concentrations and adjusting dalteparin dose accordingly can reduce the risk of VTE in high-risk trauma patients 3.
• Dalteparin is safe and effective for VTE prophylaxis in elderly medical patients with renal insufficiency 4.
• Anti-Xa-guided enoxaparin thromboprophylaxis may be more effective than fixed-dose dalteparin in trauma patients admitted to intensive care 5.
• Renal function affects the pharmacokinetics of dalteparin, and dose adjustment may be necessary in patients with renal insufficiency 6.
• Dalteparin may be a suitable alternative to enoxaparin for VTE prophylaxis in a real-world setting 7.