Use this guideline only in patients with VTE
BEFORE STARTING TREATMENT
- Check FBC, INR and APTT, U&E, LFT
- Always weigh patient
- do NOT guess the body weight or rely on patient’s own estimate
- Consider risk of bleeding. See next section
- Consider need for monitoring, especially Heparin-induced thrombocytopenia or Anti-Xa monitoring. See MONITORING DALTEPARIN TREATMENT below
DOSE
Increased risk of bleeding
- Adjust dalteparin doses with advice from appropriate team
Pregnancy
- Contact obstetric team
Daily dalteparin dose: pregnant
Enter early pregnancy or booking weight in kg (all weights entered to nearest round figure):
Renal failure (eGFR <20)
- Contact renal team
Daily dalteparin dose: eGFR < 20
Enter weight in kg (all weights entered to nearest round figure):
Severe liver failure
- Contact liver team for advice on doses
Thrombocytopenia or defective platelet function
- If platelet count <100 x 109/L or defective platelet function, seek advice from on-call haematologist before starting anticoagulation
- If platelet count ≥100 x 109/L, or if advised by haematologist, start dalteparin
Following surgery, trauma or haemorrhagic stroke
- Adjust dalteparin dose accordingly with advice from appropriate team
Standard doses of SC Dalteparin
- Check any increased risk of bleeding
Enter weight in kg (all weights entered to nearest round figure):
Enter weight in kg (all weights entered to nearest round figure):
MONITORING DALTEPARIN TREATMENT
Patient
- If required, arrange for outpatient to return daily for further SC injections of dalteparin sodium
- Check they have an advice sheet
Heparin-induced thrombocytopenia
- In a medical patient who has not been given unfractionated heparin, monitoring for heparin-induced thrombocytopenia is not required
- If patient is being, or has (in last 3 months) been, treated with unfractionated heparin or is a post-operative surgical patient being treated with LMWH:
- check platelet count on alternate days starting from day 4 until day 14 of heparin treatment (from day 2 if patient has been given heparin in preceding 100 days).
- compare platelet count with pre-treatment result – see Heparin-induced thrombocytopenia guideline
Anti-Xa monitoring
- If patient weighs, or early pregnancy weight was <50 kg or >90 kg, or patient has bleeding problems, renal impairment, or massive PE, discuss need for anti-Xa monitoring with haematology consultant
© 2022 The Bedside Clinical Guidelines Partnership.
Created by University Hospital North Midlands and Keele University School of Computing and Mathematics.
Research and development team: James Mitchell, Ed de Quincey, Charles Pantin, Naveed Mustfa