• 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

• Acute bacterial endocarditis
• Major trauma
• Epidural and spinal anaesthesia
• Haemophilia or other haemorrhagic disorders
• Active peptic ulcer
• Recent cerebral haemorrhage
• Recent surgery to eye or nervous system
• Thrombocytopenia (including history of heparin-induced thrombocytopenia)

Increased risk of bleeding

• Adjust dalteparin doses with advice from appropriate team

Pregnancy

• Contact obstetric team

Renal failure (eGFR <20)

• Contact renal team

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 at standard dose

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

Extended treatment of SC dalteparin for non-pregnant patients with eGFR ≥20 mL/min and with solid tumour

Daily dose for administration of SC dalteparin for non-pregnant patients with eGFR ≥20 mL/min

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 low molecular weight Heparin (LMWH) e.g. Dalteparin:
• 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