| When neuraxial anesthesia (epidural/spinal anesthesia) or spinal puncture is employed, patients anticoagulated or scheduled to be anticoagulated with low molecular weight heparins or heparinoids for prevention of thromboembolic complications are at risk of developing an epidural or spinal hematoma which can result in long-term or permanent paralysis. Caution is recommended in thrombocytopenia and platelet defects, severe liver and kidney insufficiencies, uncontrolled hypertension, hypertensive or diabetic retinopathy. It is recommended that platelets be counted before start of Dalteparin treatment. During Dalteparin administration, special caution is necessary in rapidly developing thrombocytopenia (<100,000/ml). Patients undergoing acute haemodialysis have a narrower therapeutic dosage range and should be subjected to comprehensive monitoring of anti-Xa levels. There is limited experience of safety and efficacy in children. Do not administer by intramuscular route. |