Dalteparin is a
low molecular weight heparin (
LMWH) with a mean molecular weight of 5000. Compared with
unfractionated heparin (UFH), the
drug has markedly improved bioavailability and increased plasma elimination half-life, and exerts a greater inhibitory effect on plasma activity of
coagulation factor Xa relative to its effects on other coagulation parameters.
Dalteparin also has less lipolytic activity than UFH.
Dalteparin 2500U once daily subcutaneously is of similar antithrombotic efficacy to UFH 5000IU twice daily, and 2 studies have shown superiority over UFH 2 or 3 times daily of
dalteparin 5000U once daily in patients requiring surgical thromboprophylaxis. After
total hip arthroplasty,
dalteparin was superior to adjusted-dosage
warfarin and was of greater thromboprophylactic efficacy when given for 35 than for 7 days. Intravenous or subcutaneous
dalteparin is as effective as intravenous UFH when given once or twice daily in the initial management of established
deep vein thrombosis (DVT). The
drug is also effective in long term home treatment.
Dalteparin has been shown to be effective in combination with
aspirin in the management of unstable
coronary artery disease (CAD), with composite end-point data from 1 study suggesting benefit for up to 3 months. Current data indicate potential of the
drug in the management of acute
myocardial infarction (MI).
Dalteparin is also of similar efficacy to UFH, with a single bolus dose being sufficient in some patients, in the prevention of clotting in haemodialysis and haemofiltration circuits. Pharmacoeconomic data indicate that overall costs relative to UFH from a hospital perspective can be reduced through the use of
dalteparin in patients receiving treatment for
venous thromboembolism.
Dalteparin has also been shown to be cost effective when used for surgical thromboprophylaxis. Overall, rates of haemorrhagic complications in patients receiving
dalteparin are low and are similar to those seen with UFH.
CONCLUSIONS:
Dalteparin is effective and well tolerated when given subcutaneously once daily in the prophylaxis and treatment of thromboembolic disease. The simplicity of the administration regimens used and the lack of necessity for laboratory monitoring facilitate home or outpatient treatment and appear to translate into cost advantages from a hospital perspective over UFH or
warfarin.
Dalteparin also maintains the patency of haemodialysis and haemofiltration circuits, with beneficial effects on blood
lipid profiles and the potential for prophylaxis with a single bolus injection in some patients. Data are also accumulating to show
dalteparin to be an effective and easily administered alternative to UFH in patients with CAD.