Fragmin (dalteparin sodium) / Pfizer, Eisai - LARVOL DELTA

Double pylorus in an elderly female patient: a case report. (PubMed, J Med Case Rep) - "Double pylorus is a rare but clinically relevant condition that may first be detected when complications such as gastrointestinal bleeding occur. Reported associations with H. pylori infection and nonsteroidal anti-inflammatory drug exposure represent observational trends rather than established causal relationships, as the evidence remains heterogeneous and limited. The condition likely develops in the setting of multifactorial impairment of gastroduodenal mucosal integrity, particularly in older or medically vulnerable individuals."

Journal • Gastroenterology • Gastrointestinal Disorder • Infectious Disease • Musculoskeletal Diseases • Orthopedics • Pain • Peptic Ulcer

Impact of postoperative weight loss on anticoagulant dosing after major lower limb amputation. (PubMed, Ann R Coll Surg Engl) - "Major amputation is associated with clinically relevant postoperative weight loss, yet anticoagulant dose adjustments were uncommon. Routine postoperative weight monitoring and prompt review of weight-based therapy are recommended to improve dosing accuracy and reduce potential anticoagulation risk."

Journal

Spontaneous inferior epigastric artery hemorrhage in a COVID-19 patient with membranous nephropathy on anticoagulant therapy: a Case Report. (PubMed, Front Med (Lausanne)) - "Despite prophylactic anticoagulation with dalteparin, her respiratory status deteriorated, requiring intensive care...It underscores the need for individualized anticoagulation strategies, pharmacodynamic monitoring, and multidisciplinary decision-making to mitigate risks in this high-risk population. The interplay of COVID-19-induced coagulopathy, renal impairment, and immunosuppressive therapy amplifies both thrombotic and hemorrhagic tendencies, necessitating extreme vigilance in clinical management."

Journal • Acute Respiratory Distress Syndrome • Critical care • Glomerulonephritis • Hematological Disorders • Infectious Disease • Novel Coronavirus Disease • Pneumonia • Pulmonary Disease • Renal Disease • Respiratory Diseases

Discovery of a Piperazine-Based Quaternary Ammonium Macrocycle as a Universal Reversal Agent for Heparin Anticoagulants. (PubMed, J Med Chem) - "Here, we report that a piperazine-derived tetracationic macrocycle can efficiently neutralize both UFH and LMWHs, including dalteparin, enoxaparin, and nadroparin. In vitro and in vivo assays reveal that the compound outperforms protamine, exhibiting significantly improved neutralization activity, a broad therapeutic window for all heparins, and high biocompatibility, which is confirmed by its very low coagulation and hemolysis effect, as well as a high therapeutic index (20.5), defined as the ratio of the maximum tolerated dose to the effective therapeutic dose. Molecular dynamics simulations indicate that binding may occur through interlocked threading and direct contact patterns, which are stabilized by intermolecular hydrogen bonding and ion-pair electrostatic attraction."

Journal • Hematological Disorders

Prophylaxis for venous thromboembolism in traumatic brain injury: protocol for a randomised controlled trial. (PubMed, BMJ Open) - P3 | "The study design is a Bayesian adaptive RCT comparing early (within three calendar days of injury) versus delayed (after study Day 7) VTE prophylaxis with the LMWH, dalteparin...The results of this trial will help guide clinicians aiming to balance the risks and benefits of early anticoagulant prophylaxis after TBI and will inform guideline development. NCT03559114."

Clinical protocol • Journal • Cardiovascular • CNS Disorders • Critical care • Vascular Neurology • Venous Thromboembolism

The Necessity to Provide an Informed Choice Regarding Venous Thromboembolism Prophylaxis: A Single-Centre Study Observing Clinician Adherence and Opinions on Venous Thromboembolism Prophylaxis. (PubMed, Cureus) - "These are often done via nonpharmacological methods, such as anti-embolic (TED™) stockings, or with pharmacological methods, such as low molecular weight heparin (LMWH), which consists of medications such as dalteparin...Fondaparinux sodium, a fully synthetic alternative, offers a non-animal-derived option, yet its use remains limited...This demonstrates a clear health inequality. Educational initiatives and institutional protocols are recommended to promote patient-centred care and ensure ethical prescribing consistent with individual values."

Journal • Cardiovascular • Venous Thromboembolism

The win ratio for evaluating edoxaban versus dalteparin for cancer-associated venous thromboembolism: an analysis of the randomized Hokusai VTE cancer trial. (PubMed, J Thromb Haemost) - "We observed no significant difference between edoxaban and dalteparin for the treatment of cancer-associated VTE when using the win-ratio approach with a hierarchy of 10 prioritized outcomes."

Journal • Cardiovascular • Hematological Disorders • Oncology • Venous Thromboembolism

MAGNOLIA: A Study Comparing Abelacimab to Dalteparin in the Treatment of Gastrointestinal/Genitourinary Cancer and Associated VTE (clinicaltrials.gov) - P3 | N=417 | Active, not recruiting | Sponsor: Anthos Therapeutics, Inc. | Recruiting ➔ Active, not recruiting | N=1020 ➔ 417

Enrollment change • Enrollment closed • Cardiovascular • Genito-urinary Cancer • Oncology • Respiratory Diseases • Solid Tumor • Venous Thromboembolism

STrategies for Anticoagulation in Patients With thRombocytopenia and Cancer-associated Thrombosis (clinicaltrials.gov) - P4 | N=50 | Recruiting | Sponsor: Tzu-Fei Wang | Trial completion date: Mar 2025 ➔ Jan 2027 | Trial primary completion date: Oct 2024 ➔ Dec 2026

Trial completion date • Trial primary completion date • Cardiovascular • Oncology • Thrombocytopenia • Thrombosis

CRITICALKidsTP: Collaborative Risk-stratified Investigation in Teen Inpatients With Critical Illness: Anticoagulation With LMWH in Kids for ThromboProphylaxis (CRITICAL-Kids-TP) (clinicaltrials.gov) - P3 | N=802 | Not yet recruiting | Sponsor: Johns Hopkins All Children's Hospital | Trial completion date: Jun 2030 ➔ Jun 2031 | Trial primary completion date: Jun 2029 ➔ Jun 2030

Trial completion date • Trial primary completion date • Cardiovascular • Venous Thromboembolism

Thrombosis and outcomes in hematologic neoplasia: Experience from a specialized cancer center in a developing country (ASH 2025) - "Inclusion criteria were adult patients (≥18 years) with a diagnosis of a hematologicmalignancy who presented a thrombotic episode after diagnosis and received anticoagulation therapybased on the institutional protocol (Dalteparin 200 IU/kg during the first month, followed by 150 IU/kgthereafter)...In this study, obesity and female gender were identified as independent predictors of recurrentthrombosis despite guideline-based LMWH therapy. Younger age was associated with a slightly higherrisk of bleeding events. No clinical characteristic was significantly associated with death followingthrombotic episodes, though statistical power may have been limited due to small sample size resultingfrom loss of follow-up."

Genetic Disorders • Hematological Malignancies • Hodgkin Lymphoma • Leukemia • Lymphoma • Multiple Myeloma • Non-Hodgkin’s Lymphoma • Obesity • Respiratory Diseases • Thrombosis • Venous Thromboembolism

Undiagnosed patent foramen ovale with bi-atrial thrombus in transit: A case of pulmonary embolism and refractory hypoxia (ASH 2025) - "She was started on weight-based low-molecular-weight heparin(dalteparin) without dose capping.Despite therapeutic anticoagulation, the patient remained persistently hypoxic throughout herhospitalization, requiring 4 L/min of supplemental oxygen via nasal cannula to maintain oxygensaturation above 92%...The patient's postoperative course was complicated by infective endocarditis involvingher pulmonic valve; however, she recovered and was transitioned to warfarin for ongoinganticoagulation...In these cases, surgical thrombectomy with PFO closure tends to lead to better outcomescompared to anticoagulation or thrombolysis alone by decreasing the risk of systemic embolization anddeath. In cases of PE accompanied by persistent hypoxia or clinical deterioration, a thrombus in transitshould be considered early in the diagnostic process to guide timely, definitive treatment."

Clinical • Cardiovascular • Gastroenterology • Genetic Disorders • Hematological Disorders • Hypotension • Obesity • Pulmonary Arterial Hypertension • Pulmonary Disease • Pulmonary Embolism • Respiratory Diseases • Venous Thromboembolism

BH08 Unprovoked pulmonary emboli in a patient with alopecia areata treated with ritlecitinib: a case report. (PubMed, Br J Dermatol) - "The efficacy of ritlecitinib, an oral Janus kinase 3/TEC family inhibitor, has been demonstrated in the Allegro clinical trials...The US Food and Drug Administration issued black box warnings, citing increased risks of major adverse cardiovascular events, malignancies, venous thromboembolism (VTE) and mortality based on data from tofacitinib, baricitinib and upadacitinib in rheumatoid arthritis...The patient received intravenous broad-spectrum antibiotics for sepsis of unknown origin, hydrocortisone and vasopressor support for hypotension. She was anticoagulated with dalteparin and transitioned to apixaban as per respiratory advice for unprovoked pulmonary emboli...This case highlights a probable severe adverse event associated with ritlecitinib therapy, including pulmonary emboli and infection of unidentified source, associated with new-onset atrial fibrillation and acute kidney injury in a patient without known risk factors for VTE. Ongoing pharmacovigilance is..."

Journal • Acute Kidney Injury • Alopecia • Atrial Fibrillation • Cardiovascular • Dermatology • Endocrine Disorders • Hematological Disorders • Herpes Zoster • Hypotension • Immunology • Infectious Disease • Inflammatory Arthritis • Influenza • Musculoskeletal Pain • Nephrology • Novel Coronavirus Disease • Oncology • Pain • Pneumococcal Infections • Pruritus • Pulmonary Embolism • Renal Disease • Respiratory Diseases • Rheumatoid Arthritis • Rheumatology • Septic Shock • Varicella Zoster • Venous Thromboembolism • CRP • JAK3

Comparative safety of enoxaparin versus other low-molecular-weight heparins in cancer-associated venous thromboembolism: a real-world cohort study from RIETE. (PubMed, Res Pract Thromb Haemost) - "In this large, observational study, enoxaparin, particularly in twice-daily regimens, was associated with significantly increased risks of bleeding and mortality compared to tinzaparin/dalteparin. These findings may help refine LMWH selection and dosing strategies in patients with cancer-associated VTE and warrant further investigation in prospective studies."

Journal • Real-world evidence • Cardiovascular • Oncology • Venous Thromboembolism

Nucleotide-Dependent Actin Conformations Revealed by Multiscale Enhanced Sampling. (PubMed, Biophys J) - "As a simple model of F-actin, we adopted recent high-resolution crystal structures of actin complexed with actin-binding protein, fragmin domain-1...These results explain the directional nature of filament formation that ATP-bound G-actin preferentially associates with the barbed end, while ADP-bound F-actin dissociates from the pointed end. Atom contact analysis clarified that the γ-phosphate in ATP binding to actin subdomain 1 contributes to nucleotide-dependent actin flexibility."

Journal

Apixaban Concentrations and Effects on Coagulation in Patients With Nephrotic Syndrome. (PubMed, Kidney Med) - P1/2 | "Guidelines recommend prophylactic anticoagulation with warfarin or low molecular weight heparin...Patients with NS received weight-adjusted dalteparin for at least 4 days, followed by a washout period of ≥ 24 hours, before starting apixaban 5 mg twice daily for a minimum of 4 days...This supports apixaban as a viable alternative for thromboprophylaxis in NS. ClinicalTrials.gov: NCT04850378; EudraCT: 2019-001212-29."

Journal • Cardiovascular • Glomerulonephritis • Nephrology • Renal Disease • Venous Thromboembolism

High intensity interval training and dalteparin attenuate doxorubicin induced cardiac damage and FoxO4 protein level in rats. (PubMed, Sci Rep) - "The HIIT program and DAL treatment significantly reduced tissue damage, enhanced cardiac function, and decreased FoxO4 expression in rats. These findings suggest that these strategies may help mitigate DOX-related cardiac injury."

Journal • Preclinical • Cardiovascular • Fibrosis • Immunology • Oncology

HIPSTER-Pilot: Hip Fracture Surgery Arterial and Venous Thrombotic Events Prevention (clinicaltrials.gov) - P3 | N=100 | Not yet recruiting | Sponsor: McMaster University

New P3 trial • Cardiovascular • Musculoskeletal Diseases • Orthopedics • Venous Thromboembolism

Updated Meta-Analysis of Randomized Controlled Trials on Primary Outpatient Thromboprophylaxis (POTP) in Patients with Lung Cancer Receiving Chemotherapy (ASH 2023) - "The prophylactic doses of bemiparin, certoparin, dalteparin, nadroparin, semuloparin and tinzaparin, intermediate dose of enoxaparin and prophylactic dose of rivaroxaban and apixaban were used in the studies. In our subgroup meta-analysis of POTP with DOACs, there was no statistically significant difference in reduction of VTE in LC patients with Khorana Score ≥2. Hence, the selection of appropriate patients who are high risk for VTE is crucial and further studies are required to define high risk subsets of LC patients receiving chemotherapy who may benefit from POTP."

Retrospective data • Cardiovascular • Lung Cancer • Oncology • Solid Tumor • Venous Thromboembolism

Impact of Obesity on Anticoagulation Dosing and Clinical Outcomes in Pediatric Patients with Venous Thrombo-Embolism (ASH 2024) - "Anticoagulants used included LMWHs (enoxaparin [78.4%], dalteparin [n=1.9%], and tinzaparin [n=1.9%]) followed by UFH (17.4%) and were comparable between obese and non-obese children (p=0.797). Conclusion : In children receiving therapeutic anticoagulation for VTE, mostly treated with enoxaparin, obesity was associated with lower anticoagulation requirements. Further prospective work is urgently needed to explore alternate dosing regimens in obese pediatric patients, such as dose capping, reduced initial dosing, or the use of fat-free mass."

Clinical • Clinical data • Cardiovascular • Genetic Disorders • Heart Failure • Obesity • Pediatrics • Venous Thromboembolism

Enoxaparin Versus Dalteparin for Venous Thromboembolism Prophylaxis in Hip and Knee Arthroplasty: A Systematic Review. (PubMed, Cureus) - "Current evidence is limited by the small number and quality of studies. Further high-quality randomised trials are needed to confirm these findings and inform clinical decision-making."

Journal • Review • Cardiovascular • Musculoskeletal Diseases • Orthopedics • Pain • Respiratory Diseases • Venous Thromboembolism

Nationwide Analysis of Anticoagulation Therapy Expenditure and Utilization during COVID-19 Pandemic (ASH 2024) - "Other DOACs, such as Rivaroxaban, reflected a decrease in average Medicare spending per beneficiary by 3%, with an 11% increase in total beneficiaries...Average spending per claim with Edoxaban was $617 in 2022, compared to 802$ with apixaban.In contrast to DOACs, total Medicare spending on warfarin decreased by 39%, and Medicaid spending by 33% with total beneficiaries decreasing by 22%...Total Medicare beneficiaries for Dalteparin in 2022 were 111 compared to 298,965 for enoxaparin. Total spending on Dabigatran and Fondaparinux decreased markedly, with a decrease in both the total number of beneficiaries and average spending/claim.Discussion : DOACs continue to be a substantial financial burden for both patients and the healthcare system in terms of prescription cost. However, our study did not consider the logistic parameters such as co-pay for patient's PT/INR testing, working hours lost to commute to the coumadin clinic saved by using DOACs. DOACs are more..."

Infectious Disease • Novel Coronavirus Disease

A Multicenter Prospective Cohort Study on the Use of Weight-Adjusted Dalteparin in Patients Over 90 kg With Acute Cancer-Associated Venous Thromboembolism-The WAVe Study. (PubMed, Am J Hematol) - P2 | "Our results suggest that weight-adjusted dosing of dalteparin in patients over 90 kg is associated with acceptable rates of bleeding and thrombosis. Trial Registration: NCT03297359."

Journal • Cardiovascular • Genetic Disorders • Hematological Disorders • Oncology • Venous Thromboembolism

Clinical use and safety of empiric anticoagulation during diagnostic work-up for deep vein thrombosis. (PubMed, Hematology) - P3 | "Enoxaparin was prescribed to 303 patients (94.2%), while 25 patients (7.6%) received dalteparin. Bleeding complications were low, indicating that empiric anticoagulation was safe. Empiric anticoagulation was often prescribed irrespective of the pre-test probability score and the bleeding risk.Trial registration: ClinicalTrials.gov identifier: NCT02486445."

Journal • Cardiovascular • Hematological Disorders • Pulmonary Embolism • Respiratory Diseases • Thrombosis • Venous Thromboembolism

OVERDOSE OF LOW MOLECULAR WEIGHT HEPARIN IN AN INFANT WITH STAGE 5 CHRONIC KIDNEY DISEASE TREATED WITH HAEMOFILTRATION (ESPN 2025) - "Dalteparin inhibits factor Xa and thrombin... The optimal management of LMWH overdose is not well documented in the literature. Protamine used to treat LMWH overdose only has a partial reversal affect. Given the infant's severe renal impairment and risks of bleeding associated with further protamine, a trial extracorporeal therapy with (CVVH) was proposed, despite limited literature describing its use."

Cardiovascular • Chronic Kidney Disease • Nephrology • Pediatrics • Renal Disease • Thrombosis