Dalteparin - An update of its pharmacological properties and clinical efficacy in the prophylaxis and treatment of thromboembolic disease

Dalteparin is a low molecular weight heparin (LMWH) with mean molecular wei ght of 5000. Compared with unfractionated heparin (UFH), the drug has marke dly improved bioavailability and increased plasma elimination half-life, an d exerts a greater inhibitory effect on plasma activity of coagulation fact or Xa relative to its effects on other coagulation parameters. Dalteparin a lso has less lipolytic activity than UFH. Dalteparin 2500U once daily subcutaneously is of similar antithrombotic eff icacy 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 w hen given once or twice daily in the initial management of established deep vein thrombosis (DVT). The drug is also effective in long term home treatm ent. Dalteparin has been shown to be effective in combination with aspirin in th e 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 infar ction (MI). Dalteparin is also of similar efficacy to UFH, with a single bo lus dose being sufficient in some patients, in the prevention of clotting i n haemodialysis and haemofiltration circuits. Pharmacoeconomic data indicate that overall costs relative to UFH from a ho spital perspective can be reduced through the use of daltepnrin in patients receiving treatment for venous thromboembolism. Dalteparin has also been s hown to be cost effective when used for surgical thromboprophylaxis. Overall, rates of haemorrhagic complications in patients receiving daltepar in are low and are similar to those seen with UFH. Conclusions: Dalteparin is effective and well tolerated when given subcutan eously once daily in the prophylaxis and treatment of thromboembolic diseas e. The simplicity of the administration regimens used and the lack of neces sity for laboratory monitoring facilitate home or outpatient treatment and appear to translate into cost advantages from a hospital perspective over U FH or warfarin. Dalteparin also maintains the patency of haemodialysis and haemofiltration circuits, with beneficial effects on blood lipid profiles a nd the potential for prophylaxis with a single bolus injection in some pati ents. Data are also accumulating to show dalteparin to be an effective and easily administered alternative to UFH in patients with CAD.