Dalteparin
Dalteparin sodium
Also known as: Boxol · Fragmine · Ligofragmin · Low Liquemine · Daltaparinum natricum · Kabi-2165
Reviewed by the VetSheet Veterinary TeamUpdated Apr 5, 2026Evidence-based veterinary reference
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Dosing by species
🌎 NA — North America🌍 EU — Europe
Dogs
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Thromboembolic disease prophylaxis/treatment | 150 Units/kg | SC | q8h | — | 🌎 NA |
| Thromboembolic disease prophylaxis/treatment | 150 Units/kg | SC | TID or BID | — | 🌎 NA |
- Thromboembolic disease prophylaxis/treatment: Initial dose 150 Units/kg SC q8h.
- Thromboembolic disease prophylaxis/treatment: 150 Units/kg SC three times daily; twice daily dosing may be effective. Studies are ongoing.
Cats
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Thromboembolic disease prophylaxis/treatment | 150 Units/kg | SC | q4h | — | 🌎 NA |
| Thromboembolic disease prophylaxis/treatment | 180 Units/kg | SC | q4-6h | — | 🌎 NA |
- Thromboembolic disease prophylaxis/treatment: Required to maintain a therapeutic target of anti-XA activity of 0.5-1 IU/mL.
- Thromboembolic disease prophylaxis/treatment: Current clinical dose recommendation.
Horses
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Prophylaxis of coagulation disorders in colic patients | 50 Units/kg | SC | q24h | — | 🌎 NA |
- Prophylaxis of coagulation disorders in colic patients: Once daily dosing.
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Overview
Dalteparin sodium is a low molecular weight (fractionated) heparin (LMWH) used primarily for the prevention and treatment of thromboembolic diseases.
- Mechanism Advantage: Unlike unfractionated heparin (UFH), LMWHs like dalteparin have a more predictable pharmacokinetic profile and preferentially target Factor Xa over thrombin, reducing the risk of spontaneous hemorrhage.
- Veterinary Challenges: While highly effective in humans with once or twice daily dosing, dogs and especially cats eliminate dalteparin very rapidly. This necessitates frequent subcutaneous injections (up to every 4-6 hours in cats), which can make long-term outpatient management highly impractical and expensive.
- Clinical Utility: Often utilized in critical care settings for patients at high risk of thrombosis (e.g., immune-mediated hemolytic anemia, protein-losing nephropathy, feline aortic thromboembolism, or equine colic).
Mechanism of action
Dalteparin exerts its anticoagulant effect by binding to and accelerating antithrombin III (ATIII).
- Conformational Change: Binding induces a conformational change in ATIII, significantly accelerating its ability to inactivate coagulation factors.
- Factor Xa Selectivity: Because dalteparin consists of shorter polysaccharide chains (average molecular weight ~5000 daltons) compared to unfractionated heparin, it lacks the chain length required to simultaneously bridge ATIII and thrombin (Factor IIa). Therefore, it preferentially inhibits Factor Xa.
- Pathway: Dalteparin + ATIII → Potent inhibition of Factor Xa → Decreased conversion of prothrombin to thrombin → Prevention of fibrin clot formation.
Clinical Pearl: Because it minimally impacts thrombin, routine clotting times like TT or aPTT are usually unaffected and are poor monitoring tools for this drug.
Safety & warnings
Contraindications
- Hypersensitivity to dalteparin, heparin, or pork products
- Active major bleeding
- Heparin-induced thrombocytopenia
- Thrombocytopenia associated with positive in vitro tests for anti-platelet antibodies in the presence of dalteparin
- Intramuscular (IM) or Intravenous (IV) administration
Adverse effects
- Hemorrhage (unlikely but possible)
- Injection site hematomas or pain
- Allergic reactions
- Neurologic sequelae secondary to epidural or spinal hematomas
Precautions
Use cautiously in patients with significant renal dysfunction as drug accumulation could result. Use with extreme caution in patients with increased risk of hemorrhage. Do not administer via IM or IV routes; must be given via subcutaneous injection only. Cannot be used interchangeably with other LMWHs or heparin sodium, as dosages differ for each. May cause asymptomatic, fully-reversible increases in AST or ALT.
Drug interactions
Increased risk for hemorrhage
Increased risk for hemorrhage
Increased risk for hemorrhage
Increased risk for hemorrhage
Monitoring
- Baseline and ongoing CBC (with platelet count)
- Urinalysis
- Stool occult blood test
- Factor Xa activity (Note: To measure peak anti-Xa activity in cats, sample at 2 hours post-dose)
Pharmacokinetics
Half-life
Absorption
Dogs: Completely absorbed after SC injection. Humans: Rapidly absorbed with a bioavailability of about 87%; peak plasma levels occur in about 4 hours.
Distribution
Dogs: Volume of distribution is 50-70 mL/kg.
Metabolism
Primarily depolymerized in the reticuloendothelial system and liver.
Elimination
Excreted via the kidneys in the urine. Half-life may be prolonged in patients with renal dysfunction.
Overdose
Overdosage may lead to hemorrhagic complications.
If treatment is necessary, protamine sulfate via slow IV may be administered.
- Dose ratio: 1 mg of protamine sulfate can inhibit the effects of 100 units of administered anti-Xa dalteparin.
- Caution: Avoid overdoses of protamine, as it has its own anticoagulant properties and can cause severe hypotension or anaphylactoid reactions.
Available products
Formulations
- Injection (single-dose syringes)
- Injection (multi-dose vials)
Human-labeled
- Dalteparin Sodium Injection (single dose syringes): 2500 Units to 18,000 Units
- Dalteparin Sodium Injection (multi-dose vials): 95,000 Units per 9.5 mL (64 mg/mL), contains benzyl alcohol
Regulatory status
No regulatory data for: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Storage & stability
Store at controlled room temperature (20-25°C, 68-77°F). Do not use if particulate matter or discoloration occur. Once the multi-dose vial is punctured, store at room temperature; discard any unused solution after 2 weeks. Commercially available dalteparin solution is stable when drawn into syringes for up to 30 days when stored at room temperature or refrigerated.
Client information
Important: Dalteparin is a blood thinner used to prevent dangerous blood clots. It must be given exactly as prescribed to be effective.
- Administration: Given by subcutaneous (under the skin) injection. If not using pre-filled syringes, use a very small gauge insulin or tuberculin syringe and needle (e.g., 27 gauge) as directed by your veterinarian.
- Technique: Rotate injection sites to minimize soreness. Do not rub the injection site after giving the medication, as this can cause bruising or hematomas.
- Missed Doses: Consistency is critical. If doses are skipped or not given regularly, life-threatening blood clots can form.
- Watch for Bleeding: Contact your veterinarian immediately if you notice:
- Unexplained bruising, swelling at the injection site, or bleeding from the gums/nose.
- Dark, tarry stools or blood in the urine.
- Extreme lethargy, weakness, pale gums, or difficulty breathing.
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturer’s current label.