Generic Name: Dalteparin Trade name: Fragmin

Pharmacologic Class: Anticoagulant/Antithrombotic agent Usual dose:

Injection dosage: 120 IU/kg SC q12 hr for 5-8 days (max
10,000 IU)

DVT prophylaxis:2,500 OR 5000 IU SC once daily, duration

Action (What does it do? How long does it take to work?):
Potentiates the inhibitory effect of antithrombin III on
coagulation factor Xa and thrombin. The resultant thrombin
inhibition prevents the formation of fibrin clots (blood clots).
= decreased incidence of death or recurrent MI
12-14 days
Uses for this medication:
Prevention of deep vein thrombosis (DVT) and pulmonary
embolism (PE) in surgical or medical patients. Prevention of
ischemic complications (with aspirin) in patients with unstable
angina, non–Q–wave MI.

Common side effects:

- dizziness, headache, insomnia, edema, constipation, N/V, reversible ↑ in liver enzymes
- pain, bruising, or swelling where the medication was injected
- Derm: ecchymosis (bruising), pruritis, rash, urticaria – hypersensitivity
- Hemat: bleeding (incl. excessive menstrual bleeding), anemia, thrombocytopenia

Clinical Judgment
Pre-administration assessment: What should the nurse assess before administering the medication?
- Assess for signs of bleeding and hemorrhage: bleeding gums, nosebleeds, unusual bruising, black/tarry stools,
hematuria
- Labs – CBC: Hct, Platelets, Hgb
- Vital signs – BP, temp, pulse, RR
- Assess dizziness that might affect gait, balance, and other functional activities
- Hepatic function: caution in patients w/ hepatic insufficiency, higher risk of hemorrhage
- Renal function: half-life of dalteparin may be prolonged
- Electrolytes – LMWHs can suppress secretion of aldosterone leading to hyperkalemia

Post- administration assessment: What should the nurse assess after administering the medication? How will you know if the
medication is effective?
- Monitor symptoms of DVT (pain, swelling, warmth, redness) to determine if effective – can use Doppler ultrasound
- Assess injection site for pain, swelling & irritation
- Vital signs – unexpected drop in BP and Hct may be sign of bleeding
- Monitor for HIT (heparin-induced thrombocytopenia)
- Monitor for hypersensitivity reactions
- Monitor CBC with platelets and D-dimer studies
- Monitor liver function studies – may cause asymptomatic ↑ in ALTs & ASTs

Nursing considerations:
- Teach client to report any symptoms of unusual bleeding or bruising to HCP immediately
- Do not concurrently take antiplatelet agents
- Use a soft-bristled toothbrush and an electric razor
- Antidote is protamine sulfate
- “Love” nox – given in the “love handles”
- Arixtra given with thumb on the plunger, leaving the air bubble intact
- SC injections  2 inches from umbilicus, never rub site or aspirate, *mild bruising @ site is common
o Risk of bleeding ↑ by concurrent use of thrombolytics, anticoagulants, or agents that affect platelet function 
NSAIDS (Acetylsalicylic Acid - aspirin), ticlopidine, clopidogrel/Plavix, tirofiban, or eptifibatide, coumadin
 (warfarin)
- To reduce the risk of new or increased DVT: Implement early mobilization and ambulation, graduated compression
stockings, intermittent pneumatic compression pumps