Long COVID Patterns in the RECOVER-Adult Study
November 21, 2025
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Brand Name :
Fragmin
Synonyms :
Alpha-heparin
Class :
Anti-coagulants
Brand Name :
Fragmin
Synonyms :
Alpha-heparin
Class :
Anti-coagulants
Dosage Forms & StrengthsÂ
Single-dose prefilled syringe, injectionÂ
2,500 IU/0.2 mLÂ
5,000 IU/0.2 mLÂ
7,500 IU/0.3 mLÂ
12,500 IU/0.5 mLÂ
15,000 IU/0.6 mLÂ
18,000 IU/0.72 mLÂ
Non-Q-wave myocardial infarction and unstable angina:
120 IU/kg total body weight subcutaneously every 12 hours in combination with aspirin therapy (75-165mg everyday) for 5-8 days
Do not exceed 10000 IU every 12 hours
Dosing based on the weight
<50kg:5500 IU subcutaneous every 12 hours
50-59kg: 6500 IU subcutaneous every 12 hours
60-69kg: 7500 IU subcutaneous every 12 hours
70-79kg: 9000 IU subcutaneous every 12 hours
≥80kg:10000 IU subcutaneous every 12 hours
indicated for Deep vein thrombosis after Hip replacement surgery:
Beginning of the preoperative period (the evening before surgery; allow approximately 24 hours between doses)
5000 IU subcutaneously every 10-14 hours before surgery
5000 IU subcutaneous every 4-8 hours after surgery
5000 IU subcutaneous during the postoperative period administer once a day
• Day of surgery-preoperative start
Subcutaneous administration of 2500 international units within two hours of surgery
2500 international units subcutaneously 4 to 8 hours after surgery or later if hemostasis has not been achieved
Allow a minimum of 6 hours between this dose and the dose to be given on postoperative day 1, and adjust the timing of the dose on postoperative day one accordingly. Five thousand international units subcutaneously once a day during the postoperative period
• Postoperative period
2500 international units subcutaneously 4 to 8 hours after surgery or later if hemostasis has not been established; allow a minimum of 6 hours between this dosage and the dose to be administered on postoperative day 1 and alter the scheduling of the dose on postoperative day 1 appropriately 5000 international units subcutaneously once daily during the postoperative period
Therapy duration:5 to 10days after surgery
Deep vein thrombosis after abdominal surgery:
• Moderate thromboembolic risk:
2500 international units subcutaneously once a day, beginning 1 to 2 hours before surgery and continued once a day postoperatively.
• High thromboembolic risk:
may be administered as a subcutaneous injection the evening before surgery and once a day postoperatively at a dose of 5000 IU per injection or as two injections of 2500 IU, each given 1 to 2 hours apart before surgery, followed by a daily injection of 5000 IU postoperatively
Therapy duration:5-10days
Venous thromboembolism in cancer patients:
Month 1
200 IU/kg total body weight subcutaneously every day. Do not exceed 18000IU
≤56kg:10000 subcutaneous everyday
57-68kg:12500 subcutaneous everyday
69-82kg:15000 subcutaneous everyday
≥83kg:18000 subcutaneous everyday
2-6 Months
150 IU/kg total body weight subcutaneously every day. Do not exceed 18000IU
≤56kg:7500 subcutaneous everyday
57-68kg:10000 subcutaneous everyday
69-82kg:12500 subcutaneous everyday
83-98kg:15000 subcutaneous everyday
≥98kg:18000 subcutaneous everyday
Indicated for Anti-coagulation therapy (Off label):
200
IU/kg
Solutions
subcutaneously
every 12 hours
or 100 units/kg subcutaneous
Dosage Forms & StrengthsÂ
Single-dose prefilled syringe, injectionÂ
2,500 IU/0.2 mLÂ
5,000 IU/0.2 mLÂ
7,500 IU/0.3 mLÂ
12,500 IU/0.5 mLÂ
15,000 IU/0.6 mLÂ
18,000 IU/0.72 mLÂ
Indicated for Venous thromboembolism:
<4 weeks: Safety and efficacy not established
4 weeks to <2 years:150 IU/kg subcutaneous twice a day
2 to <8 years: 125 IU/kg subcutaneous twice a day
8 to <17 years: 100 IU/kg subcutaneous twice a day
Dose Adjustments
If the platelet count falls below 50,000/mmÂł, it is recommended to discontinue dalteparin until it recovers to above 50,000/mmÂł. If the platelet count is between 50,000-100,000/mmÂł, it is recommended to reduce the daily dose of dalteparin by 50% until the platelet count reaches 100,000/mmÂł
indicated for Extended Venous thromboembolism in cancer patients:
200 IU/kg subcutaneous every 30 days, then
Months 2-6, 150 IU/kg subcutaneous every day
Do not exceed 18000 units daily
Indicated for Non-Q-wave myocardial infarction and unstable angina:
120 IU/kg subcutaneous every 12 hours for 5-8 days in combination with aspirin therapy
Indicated for Deep vein thrombosis after abdominal surgery:
• Moderate thromboembolic risk:
2500 international units subcutaneously once a day, beginning 1 to 2 hours before surgery
• High thromboembolic risk:
may be administered as a subcutaneous injection the evening before surgery and once a day postoperatively at a dose of 5000 IU per injection
Indicated for Deep vein thrombosis after Hip replacement surgery:
• Day of surgery-preoperative start
Subcutaneous administration of 2500 international units within two hours of surgery
• Postoperative period
2500 international units subcutaneously 4 to 8 hours after surgery thereafter 5000IU every day
desirubin: they may increase the anticoagulant effect of anticoagulants
due to anticoagulant properties of taheebo, other anticoagulant use is contraindicated
use caution when bladderwrack is used in combination with anticoagulant medication due to antiplatelet action
bloodroot along with anticoagulant medications will result in bleeding and bruising
when combined, may increase anticoagulation
may increase the anti-coagulant action of anti-coagulants
may enhance the toxic effect of anti-coagulants
may increase the anti-coagulant action of anti-coagulants
may increase the anti-coagulant action of anti-coagulants
may increase the anti-coagulant action of anti-coagulants
may increase the anti-coagulant action of anti-coagulants
piperacillin will increase the effectiveness of dalteparin by anticoagulation.
when both drugs are combined, there may be an increased effect of dalteparin by anticoagulation  
when both drugs are combined, there may be an increased effect of dalteparin by anticoagulation  
when both drugs are combined, there may be an increased effect of dalteparin by anticoagulation  
azithromycin decreases the metabolism of dalteparin and increases its effect
may enhance the effect of anticoagulants
edoxaban increases the effect of anticoagulants
it increases the toxicity of anticoagulants
anticoagulants increase the toxicity of omacetaxine
vorapaxar increases the toxicity of anticoagulants
may have an increased anticoagulant effect when combined with anticoagulants
may have an increased anticoagulant effect when combined with anticoagulants
may have an increased thrombogenic effect when combined with anti- coagulant inhibitor complex
urokinase: they may increase the anticoagulant effect of anticoagulants
synthetic conjugated estrogens, bÂ
the activity of dalteparin may be decreased due to pharmacodynamic antagonism
thrombolytic Agents may enhance the anticoagulant effect of anticoagulants
may increase the anti-coagulant action of anti-coagulants
may increase the anti-coagulant action of anti-coagulants
may increase the anti-coagulant action of anti-coagulants
may increase the anti-coagulant action of anti-coagulants
may increase the anti-coagulant action of anti-coagulants
may increase the anti-coagulant action of anti-coagulants
may increase the anti-coagulant action of anti-coagulants
may increase the anti-coagulant action of anti-coagulants
may increase the anti-coagulant action of anti-coagulants
may increase the anti-coagulant action of anti-coagulants
may increase the anti-coagulant action of anti-coagulants
may increase the anti-coagulant action of anti-coagulants
may increase the anti-coagulant action of anti-coagulants
may increase the anti-coagulant action of anti-coagulants
may increase the anti-coagulant action of anti-coagulants
may enhance the toxic effect of anti-coagulants
may increase the anti-coagulant action of anti-coagulants
may enhance the toxic effect of anti-coagulants
may enhance the toxic effect of anti-coagulants
may enhance the toxic effect of anti-coagulants
may increase the hyperkalemic effect of diuretics
may increase the hyperkalemic effect of diuretics
may increase the hyperkalemic effect of diuretics
may increase the hyperkalemic effect of diuretics
may increase the hyperkalemic effect of diuretics
may increase the anti-coagulant action of anti-coagulants
may increase the anti-coagulant action of anti-coagulants
may increase the anti-coagulant action of anti-coagulants
may increase the anti-coagulant action of anti-coagulants
may increase the anti-coagulant action of anti-coagulants
may increase the anti-coagulant action of anti-coagulants
may increase the anti-coagulant action of anti-coagulants
may increase the anti-coagulant action of anti-coagulants
may increase the anti-coagulant action of anti-coagulants
may increase the anti-coagulant action of anti-coagulants
may enhance the adverse/toxic effect of anticoagulants
may enhance the adverse/toxic effect of anticoagulants
may enhance the adverse/toxic effect of anticoagulants
may enhance the adverse/toxic effect of anticoagulants
may enhance the adverse/toxic effect of anticoagulants
other antiplatelet agents increase the effect of anticoagulating agents
other antiplatelet agents increase the effect of anticoagulating agents
other antiplatelet agents increase the effect of anticoagulating agents
other antiplatelet agents increase the effect of anticoagulating agents
other antiplatelet agents increase the effect of anticoagulating agents
may have an increased anticoagulant effect when combined with anticoagulants
may have an increased anticoagulant effect when combined with anticoagulants
may have an increased anticoagulant effect when combined with anticoagulants
It may enhance the risk of bleeding by affecting coagulation when combined with omega-3 carboxylic acids
nonsteroidal anti-Inflammatory agents may strengthen the anticoagulant effects of anticoagulants
nonsteroidal anti-Inflammatory agents may strengthen the anticoagulant effects of anticoagulants
nonsteroidal anti-Inflammatory agents may strengthen the anticoagulant effects of anticoagulants
nonsteroidal anti-Inflammatory agents may strengthen the anticoagulant effects of anticoagulants
nonsteroidal anti-Inflammatory agents may strengthen the anticoagulant effects of anticoagulants
antiplatelet agents increase the effect of anticoagulants
may increase the anticoagulation when combined with ginkgo biloba
may have an increased anticoagulant effect when combined with vitamin k antagonists
may have an increased anticoagulant effect when combined with vitamin k antagonists
may have an increased anticoagulant effect when combined with vitamin k antagonists
may have an increased anticoagulant effect when combined with vitamin k antagonists
may have an increased anticoagulant effect when combined with vitamin k antagonists
It may enhance the risk of adverse effects when combined with Anticoagulants
It may enhance the risk of adverse effects when combined with Anticoagulants
It may enhance the risk of adverse effects when combined with Anticoagulants
It may enhance the risk of adverse effects when combined with Anticoagulants
It may enhance the risk of adverse effects when combined with Anticoagulants
When dalteparin is used together with sertraline, the risk or seriousness of bleeding may be enhanced
When dalteparin is used together with andrographolide, this leads to enhanced risk or seriousness of bleeding
when used with dalteparin, andexanet alfa's therapeutic efficacy may be compromised
dalteparin: it may decrease the therapeutic efficacy of etynodiol
dalteparin: it may decrease the therapeutic efficacy of soyabean oil
reduce therapeutic effects of dalteparin
gemcitabine, by unspecific interaction mechanism, increases the effect of dalteparin
the effect of dalteparin is increased by fluorouracil with the help of an unspecific interaction mechanism
it may increase the action of anticoagulant effect
it may increase the effect of anticoagulants
it may enhance the anticoagulant effect of anticoagulants
it may enhance the anticoagulant effect of anticoagulants
it may enhance the anticoagulant effect of anticoagulants
it may enhance the anticoagulant effect of anticoagulants
it may enhance the anticoagulant effect of anticoagulants
antiplatelet agents increase the effect of anticoagulants
antiplatelet agents increase the effect of anticoagulants
choline magnesium trisalicylate
salicylates may enhance the anticoagulant effect of anticoagulants
may enhance the adverse/toxic effect of anticoagulants
may enhance the adverse/toxic effect of anticoagulants
may enhance the adverse/toxic effect of anticoagulants
when combined may increase anticoagulation
when combined may increase anticoagulation
may increase the anticoagulant effect of anticoagulants
may increase the anticoagulant effect of anticoagulants
may increase the anticoagulant effect of anticoagulants
may increase the anticoagulant effect of anticoagulants
may increase the anticoagulant effect of anticoagulants
may increase the toxic effect of prostacyclin analogs
may enhance the anticoagulant effect of anticoagulants
may enhance the adverse/toxic effect of anticoagulants
may enhance the adverse/toxic effect of anticoagulants
may enhance the adverse/toxic effect of anticoagulants
may enhance the adverse/toxic effect of anticoagulants
may enhance the adverse/toxic effect of anticoagulants
may enhance the adverse/toxic effect of anticoagulants
may enhance the adverse/toxic effect of anticoagulants
may enhance the adverse/toxic effect of anticoagulants
may increase the anti-platelet effect of anti-coagulants agents
may have an increased anticoagulant effect when combined with Anticoagulants
bromeperidol increases the toxicity of anticoagulants
it increases the effect of anticoagulants
may enhance the nephrotoxic effect of salicylates
may have an increased adverse effect when combined with anticoagulants
may have an increased adverse effect when combined with anticoagulants
may have an increased adverse effect when combined with anticoagulants
may have an increased adverse effect when combined with ibritumomab tiuxetan
other antiplatelet agents increase the anticoagulative effect of rivaroxaban
may enhance the effect of anticoagulants
may enhance the effect of anticoagulants
may enhance the effect of anticoagulants
may enhance the effect of anticoagulants
may enhance the effect of anticoagulants
may enhance the effect of anticoagulants
may have an increased anticoagulant effect when combined with anticoagulants
may have an increased anticoagulant effect when combined with anticoagulants
may have an increased anticoagulant effect when combined with anticoagulants
may have an increasingly adverse effect when combined with deferasirox
may have an increasingly adverse effect when combined with deoxycholic acid
may decrease the therapeutic effect when combined with anticoagulants
may decrease the therapeutic effect when combined with anticoagulants
may decrease the therapeutic effect when combined with anticoagulants
may have an increasingly adverse effect when combined with nintedanib
may have an increased anticoagulant effect when combined with anticoagulants
may have an increasingly adverse effect when combined with obinutuzumab
may have an increased anticoagulant effect when combined with anticoagulants
may have an increasingly adverse effect when combined with anticoagulants
may reduce the anticoagulant effect
may reduce the anticoagulant effect
choline magnesium trisalicylate
may enhance the anticoagulant effect
may decrease the therapeutic effect of factor X
may have an increasingly adverse effect when combined with anticoagulants
may have an increased anticoagulant effect when combined with anticoagulants
may have an increased anticoagulant effect when combined with anticoagulants
may have an increasingly adverse effect when combined with anticoagulants
anticoagulation is increased by dalteparin and decreased by mistletoe. The interaction's effect is unclear; exercise caution
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may enhance the anticoagulant effects of each other when combined
may increase the anticoagulant effect when combined
they decrease the effect of each other by pharmacodynamic antagonism
they decrease the effect of each other by pharmacodynamic antagonism
they decrease the effect of each other by pharmacodynamic antagonism
they decrease the effect of each other by pharmacodynamic antagonism
they decrease the effect of each other by pharmacodynamic antagonism
may increase the risk of haemorrhage with oral anticoagulants
may increase the risk of haemorrhage with oral anticoagulants
may increase the risk of haemorrhage with oral anticoagulants
eplerenone: they may increase the anticoagulant effect of anticoagulants
vitamin E: they may increase the anticoagulant effect of anticoagulants
corticosteroids: they may increase the anticoagulant effect of anticoagulants
corticosteroids: they may increase the anticoagulant effect of anticoagulants
corticosteroids: they may increase the anticoagulant effect of anticoagulants
corticosteroids: they may increase the anticoagulant effect of anticoagulants
corticosteroids: they may increase the anticoagulant effect of anticoagulants
corticosteroids j3: they may increase the anticoagulant effect of anticoagulants
corticosteroids j3: they may increase the anticoagulant effect of anticoagulants
corticosteroids j3: they may increase the anticoagulant effect of anticoagulants
corticosteroids j3: they may increase the anticoagulant effect of anticoagulants
corticosteroids j4: they may increase the anticoagulant effect of anticoagulants
corticosteroids j4: they may increase the anticoagulant effect of anticoagulants
corticosteroids j4: they may increase the anticoagulant effect of anticoagulants
corticosteroids j4: they may increase the anticoagulant effect of anticoagulants
ceritinib: they may increase the anticoagulant effect of anticoagulants
The anticoagulant effects of ancord may be enhanced when administered concomitantly with other anticoagulants
may have an increased anticoagulant effect when combined with anticoagulants
the risk of bleeding may be increased
demeclocycline increases the effects of dalteparin by an unknown mechanism
doxycycline increases the effects of dalteparin by an unknown mechanism
caplacizumab has the potential to increase the anticoagulant activity of other anticoagulants
Mechanism of actionÂ
dalteparin is a low molecular weight heparin (LMWH). It is an anti-coagulant that helps prevent blood clots from forming.Â
The mechanism of action of dalteparin is similar to that of other LMWHs. It works by binding to and inhibiting the activity of clotting factors in the blood, including thrombin and Factor Xa. This helps prevent blood clots’ formation and reduces the risk of thrombosis.Â
SpectrumÂ
The spectrum of dalteparin includes a range of indications for which it can be used. It is commonly used to prevent and treat thrombosis, including deep vein thrombosis (DVT) and pulmonary embolism (PE). It may also be used to prevent clotting during surgery in patients with certain types of heart disease and unstable angina or non-Q-wave myocardial infarction (MI). dalteparin may also treat disseminated intravascular coagulation (DIC) in some instances.Â
Frequency defined:Â Â
1-10%Â
ThrombocytopeniaÂ
Major hemorrhageÂ
Wound hematomaÂ
Injection site hematomaÂ
Injection site painÂ
Increased liver function testÂ
HematuriaÂ
Frequency not defined:Â Â
Spinal hematomaÂ
Intracranial hemorrhageÂ
ThrombocytopeniaÂ
Epidural hematomaÂ
Hemorrhagic cerebral infarctionÂ
Post-marketing reportsÂ
Skin necrosisÂ
OsteoporosisÂ
AlopeciaÂ
Black box warningÂ
Using low molecular weight heparins (LMWHs) like dalteparin and heparinoids can increase the risk of developing epidural or spinal hematomas in patients who receive neuraxial (epidural/spinal) anesthesia or spinal puncture. Â
Epidural or spinal hematomas can result in long-term or permanent paralysis. It is important for patients receiving LMWHs or heparinoids to be monitored closely for signs and symptoms of neurologic impairment. If neurological compromise is noted, urgent treatment is necessary.Â
ContraindicationsÂ
CautionsÂ
Pregnancy consideration: It should be used cautiously in pregnant women, as it may cause fetal harmÂ
Lactation: Excretion of the drug in human breast milk is knownÂ
Pregnancy category:Â
Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester.  Â
Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women.Â
Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.   Â
Category D: adequate data available with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.   Â
Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.   Â
Category N: There is no data available for the drug under this categoryÂ
PharmacologyÂ
It works by binding to and inhibiting the activity of clotting factors in the blood, including thrombin and Factor Xa. This helps prevent blood clots formation and reduces the risk of thrombosis.Â
PharmacodynamicsÂ
It is an anticoagulant, which helps to prevent blood clots from forming. It does this by inhibiting the activity of clotting factors in the blood, which helps to reduce the risk of thrombosis (blood clots in the blood vessels).Â
When dalteparin is administered, it binds to and inhibits the activity of thrombin and Factor Xa, two proteins involved in the blood clotting process. By inhibiting their activity, dalteparin helps prevent blood clots’ formation and reduces the risk of thrombosis.Â
PharmacokineticsÂ
Absorption:Â
The peak plasma anti-Xa activity of dalteparin refers to the highest drug concentration in the blood plasma after it is administered. The peak plasma anti-Xa activity for three different doses of dalteparin: 0.19 IU/mL for the 2500 IU dose, 0.41 IU/mL for the 5000 IU dose, and 0.82 IU/mL for the 10,000 IU dose.Â
DistributionÂ
The volume of distribution (Vd) for adults is 40-60 mL/kg. The volume of distribution is a measure of how much of the drug is distributed throughout the body. A higher volume of distribution indicates that the drug is more widely distributed throughout the body.Â
MetabolismÂ
It is metabolized by various enzymes, including esterases and heparinases, which break down the drug into smaller molecules that can be eliminated from the body.Â
Elimination/ExcretionÂ
Half-life (In pediatrics)Â
Half-life (In adults)Â
In adults, the half-life of dalteparin ranges from 2.1-5.7 hours, depending on the drug’s dose. You provided the half-life of dalteparin for three different doses: 2.1 hours for the 40 IU/kg dose, 2.3 hours for the 60 IU/kg dose, and 5.7 hours for a single intravenous (IV) 5000 IU dose. Â
Clearance (In pediatrics)Â
Clearance (In adults)Â
The clearance of dalteparin for two different doses: 24.6 mL/hr/kg for the 30 IU/kg dose and 15.6 mL/hr/kg for the 120 IU/kg doseÂ
AdministrationÂ
It is important to note that dalteparin should only be administered by subcutaneous injection. It should not be given intravenously or intramuscularly.Â
Following proper infection control procedures when administering dalteparin is essential, including washing your hands and cleaning the injection site with an alcohol pad.Â
When administering dalteparin, it is essential to follow the instructions provided by your healthcare provider or the product label. The drug should be injected in a U-shaped area around the navel, the upper outer side of the thigh, or the upper outer quadrangle of the buttock. The injection site should be varied daily to avoid irritation. When injecting in the area around the navel or thigh, it is essential to lift a fold of skin with your thumb and forefinger before inserting the needle. The entire length of the needle should be inserted at a 45-90° angle.Â
When using prefilled syringes or vials of dalteparin, it is essential to inspect them visually for particulate matter and discoloration before administering the drug. Fixed-dose syringes should be used to ensure the delivery of the total dose of the drug, and the syringe assembly should be discarded after use. Graduated syringes should be used to deliver the desired dose or volume of the drug, with any excess solution discarded appropriately. The syringe assembly should also be discarded after use.Â
StorageÂ
For opened vials of dalteparin, after the first penetration of the rubber stopper, the vial should be stored at room temperature for up to 2 weeks. Any new solution in the vial should be discarded after two weeksÂ
For unopened vials of dalteparin, the vial should be stored at a temperature of 20-25°C (68-77°F). It is acceptable to store the vial at a slightly more comprehensive temperature range of 15-30°C (59-86°F)Â
Patient information leafletÂ
Generic Name: dalteparinÂ
Pronounced: [ DAL-te-PAR-in ]Â
Why do we use dalteparin?Â
A low molecular weight heparin called dalteparin is used to prevent acute cardiac ischemia events in individuals with unstable angina and non-Q-wave myocardial infarction, as well as the prevention of thrombotic events in some patientsÂ
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