達胏素
Dalteparin
Dalteparin sodium
別名: Boxol · Fragmine · Ligofragmin · Low Liquemine · Daltaparinum natricum · Kabi-2165
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
劑量為合格獸醫專業人員的臨床參考。請務必對照最新仿單及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
馬
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Prophylaxis of coagulation disorders in colic patients | 50 Units/kg | SC | q24h | — | 🌎 NA |
- Prophylaxis of coagulation disorders in colic patients: Once daily dosing.
劑量為合格獸醫專業人員的臨床參考。請務必對照最新仿單及個別病患確認。
概覽
達胏素鈉（Dalteparin sodium）是一種低分子量胏素 (LMWH)，主要用於預防和治療血栓栓塞性疾病。
- 機轉優勢：與未分畋胏素 (UFH) 相比，LMWH（如達胏素）具有更可預測的藥物動力學特性，且優先針對凝血因子 Xa 而非凝血酶，從而降低自發性出血的風險。
- 獸醫臨床挑戰：雖然在人類中每日一次或兩次給藥非常有效，但狗和貓（尤其是貓）排除達胏素的速度非常快。這需要頻繁的皮下注射（貓最多每 4-6 小時一次），使得長期門診管理變得不切實際且昂貴。
- 臨床應用：常用於重症監護環境中，針對血栓高風險患者（例如：免疫介導性溶血性貧血、蛋白流失性腎病、貓主動脈血栓栓塞或馬絞痛）。
作用機轉
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.
安全性與警告
禁忌症
- 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
不良反應
- Hemorrhage (unlikely but possible)
- Injection site hematomas or pain
- Allergic reactions
- Neurologic sequelae secondary to epidural or spinal hematomas
注意事項
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.
藥物交互作用
Increased risk for hemorrhage
Increased risk for hemorrhage
Increased risk for hemorrhage
Increased risk for hemorrhage
監測
- 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)
藥物動力學
半衰期
吸收
Dogs: Completely absorbed after SC injection. Humans: Rapidly absorbed with a bioavailability of about 87%; peak plasma levels occur in about 4 hours.
分佈
Dogs: Volume of distribution is 50-70 mL/kg.
代謝
Primarily depolymerized in the reticuloendothelial system and liver.
排除
Excreted via the kidneys in the urine. Half-life may be prolonged in patients with renal dysfunction.
過量
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.
可用產品
劑型
- Injection (single-dose syringes)
- Injection (multi-dose vials)
人用標示
- 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
各地核准狀態
暫無法規資料: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
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.
飼主須知
重要提示：達胏素是一種血液稀釋劑，用於預防危險的血栓。必須嚴格按照處方給藥才能發揮效用。
- 給藥方式：透過皮下注射給藥。如果不使用預充式注射器，請按照獸醫師的指示，使用非常細的胰島素或結核菌素注射器和針頭（例如 27 號針）。
- 注射技巧：輪換注射部位以減輕疼痛。給藥後請勿揉搓注射部位，因為這可能導致瘀青或血腫。
- 漏藥：持續性至關重要。如果漏掉劑量或沒有規律給藥，可能會形成危及生命的血栓。
- 注意出血跡象：如果您注意到以下情況，請立即聯繫您的獸醫師：
- 不明原因的瘀青、注射部位腫脹，或牙齦/鼻子出血。
- 黑色柏油狀糞便或尿液中帶血。
- 極度喰睡、虛弱、牙齦蒼白或呼吸困難。
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