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Dalteparin is a low molecular weight heparin. It is marketed as Fragmin . Like other low molecular weight heparins, dalteparin is used for prophylaxis or treatment of deep vein thrombosis and pulmonary embolism to reduce the risk of a stroke or heart attack. [ 2 ]
No dose adjustment is required in persons with renal impairment. [2] No dose adjustment is required in persons with mild and moderate hepatic impairment . If the person has severe hepatic impairment, vorapaxar is not recommended due to the risk of bleeding.
Once or twice daily subcutaneous injection for treatment of venous thromboembolism and in unstable angina instead of intravenous infusion of high-dose heparin. There is no need to monitor the APTT coagulation parameter as required for high-dose heparin. [26] Possibly a smaller risk of bleeding. Smaller risk of osteoporosis in long-term use.
The clinically approved dose of prasugrel is a 60-mg loading dose PO and a 10-mg a day maintenance dose PO. [28] Ticagrelor is a much more potent inhibitor of platelet aggregation than clopidogrel, however, it is associated with increase of dyspnoea episodes in patients. These episodes can range from mild to moderate severity.
Commonly used low molecular weight heparins are enoxaparin, dalteparin, nadroparin and tinzaparin. [5] [6] In HIT, the platelet count in the blood falls below the normal range, a condition called thrombocytopenia. However, it is generally not low enough to lead to an increased risk of bleeding.
Unlike the hirudins, bivalirudin is only partially (about 20%) excreted by the kidneys, other sites such as hepatic metabolism and proteolysis also contribute to its metabolism, making it safer to use in patients with renal impairment; however, dose adjustments are needed in severe renal impairment. [8] [16]
Side effects may include bleeding, most commonly from the nose, gastrointestinal tract (GI) or genitourinary system. [2] Compared to the risk of bleeding with warfarin use, direct factor Xa inhibitors have a higher risk of GI bleeding, but lower risk of bleeding in the brain. [2]
Thrombin demonstrates a high level of allosteric regulation. [2] Allosterism in thrombin is regulated by the exosites 1 and 2 and the sodium binding site. A recent patent review has shown that the general consensus among researchers is that allosteric inhibitors may provide a more regulatable anticoagulant. [3]