Prevention of Clotting in the Extracorporeal System During Hemodialysis and Hemofiltration
Administer dalteparin into the arterial side of the dialyzer or intravenously, selecting the appropriate regimen from those described below.
· Patients with chronic renal insufficiency or patients with no known risk of bleeding - These patients normally require few dose adjustments and, therefore, frequent monitoring of anti-Xa levels is not necessary for most patients.
o Hemodialysis and hemofiltration up to a maximum of 4 hours - A single bolus injection of 5000 IU can be administered, either intravenously or into the arterial side of the extracorporeal system, at the start of the procedure. Alternatively, administer 30 to 40 IU/kg total body weight IV bolus injection, followed by 10 to 15 IU/kg/h IV infusion.
o The 5000 IU starting dose for the single bolus dosing regimen can be adjusted, session-to-session, based on the outcome of the previous dialysis; the dose may be increased or decreased in steps of 500 or 1000 anti-Xa IU until a satisfactory outcome is obtained (see section 5.1. Pharmacodynamic properties).