Dosing Summary
| Indication | Adult Dose (Normal Renal Function, CrCl ≥30 mL/min) | Renal Impairment (CrCl <30 mL/min) | Weight-Based Adjustment | Pediatric Dose | Elderly Considerations |
|---|---|---|---|---|---|
| DVT/PE Treatment (VTE) | 200 IU/kg SC once daily (max 18,000 IU) for 1 month → then 150 IU/kg SC once daily | Use with caution; monitor anti-Xa. Consider UFH if severe CKD. | Dose capped at 18,000 IU/day | 100 IU/kg SC q12h (max 10,000 IU per dose) | Higher bleeding risk; monitor CBC, anti-Xa if renal function borderline |
| Extended VTE Treatment in Cancer | 200 IU/kg SC once daily for 1 month (max 18,000 IU) → 150 IU/kg SC once daily for months 2–6 | Same as above; avoid if CrCl <30 unless anti-Xa guided | Same max cap applies | Limited data; use 150 IU/kg q24h (monitor anti-Xa) | More cautious dosing; renal monitoring essential |
| VTE Prophylaxis (General Medical/Surgical Patients) | 2,500–5,000 IU SC once daily | 2,500 IU SC once daily with monitoring; consider UFH if high risk | Fixed dose (not weight-adjusted) | 100 IU/kg SC once daily (max 5,000 IU) | Dose as adults but with closer bleeding monitoring |
| Post-Orthopedic Surgery Prophylaxis | 2,500 IU SC 1–2 h pre-op, then 2,500–5,000 IU SC once daily | Avoid in severe renal impairment (UFH preferred) | Fixed dose | Not recommended (limited data) | Increased bleeding risk; weigh benefit vs risk |
| Unstable Angina / Non–Q-wave MI | 120 IU/kg SC q12h (max 10,000 IU/dose) with aspirin | Use with caution; anti-Xa monitoring if CrCl <30 | Max dose cap applies | Not routinely used in pediatrics | Monitor renal function and anti-Xa more closely |
Key Pharmacist Notes
- Renal clearance: Dalteparin is renally eliminated; avoid or monitor anti-Xa closely if CrCl <30 mL/min.
- Anti-Xa Monitoring (if indicated):
- Therapeutic range: 0.5–1.0 IU/mL (q24h dosing) or 0.5–1.5 IU/mL (q12h dosing).
- Elderly: Increased bleeding risk due to lower renal reserve and comorbidities.
- Weight: Treatment doses are weight-based, but capped at 18,000 IU/day.
- Pediatrics: Use weight-based dosing; limited data, monitoring essential.
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