Dalteparin,a Low-Molecular-Weight Heparin: Review of Pharmacology and Pharmacotherapy

Abstract

Objective:

To review the current literature concerning the use of dalteparin in thromboembolic disease. The chemistry, pharmacokinetics, pharmacodynamics and clinical efficacy for approved and nonapproved uses, and adverse effects are presented.

Data Sources:

A MEDLINE search of the English-language literature between 1980 and 1996.

Data Extraction:

The data presented are primarily from controlled studies of dalteparin in humans. Some of the pharmacokinetic/pharmacodynamic and basic pharmacologic data are from animal studies. The majority of the clinical investigations were blind.

Data Synthesis:

Dalteparin sodium is approved for use in the prophylaxis of thromboembolic disease after major abdominal surgery. Dalteparin is a low-molecular-weight heparin (LMWH) with a mean molecular weight of 5,000 Da. It produces its antithrombotic effect through the inhibition of activated factor X and, to a lesser extent, activated factor II.

Conclusions:

Thromboembolic disease may occur in patients such as those over 40 years of age undergoing major surgical procedures lasting longer than 30 minutes. In addition, prolonged bed rest may result in development of thromboembolism due to immobilization and venous stasis. Anticoagulant prophylaxis for deep-vein thrombosis is warranted in these patients. As with other LMWHs, laboratory monitoring of coagulation parameters (e.g., activated partial thromboplastin time and activated coagulation time) is unnecessary. Dalteparin sodium has been demonstrated to be efficacious and safe for the prophylaxis of thromboembolic disease after major abdominal surgery and is a reasonable alternative to unfractionated heparin in these patients. The use of dalteparin for other indications, such as treatment of thromboembolic disease, hemodialysis, and unstable coronary artery disease, also appears to be promising.