Comparative Pharmacology
Head-to-head clinical analysis: DICUMAROL versus FRAGMIN.
Peer-Reviewed Evidence
Head-to-head clinical analysis: DICUMAROL versus FRAGMIN.
DICUMAROL vs FRAGMIN
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Dicumarol is a vitamin K antagonist that inhibits the synthesis of vitamin K-dependent clotting factors (II, VII, IX, X) and anticoagulant proteins C and S by blocking the reduction of vitamin K epoxide to vitamin K hydroquinone in the liver.
Fragmin (dalteparin) is a low molecular weight heparin that binds to antithrombin III, potentiating its inhibition of factor Xa and, to a lesser extent, thrombin, thereby preventing thrombus formation.
Initial oral dose 200-300 mg once daily for 2-3 days, then maintenance 25-200 mg once daily adjusted to target INR of 2.0-3.0 for most indications. Administered orally.
Deep vein thrombosis prophylaxis: 2500 IU subcutaneously once daily, starting 1-2 hours before surgery and continuing postoperatively for 5-10 days or until ambulatory. Treatment of acute DVT: 200 IU/kg subcutaneously once daily, or 100 IU/kg twice daily. Unstable angina/NSTEMI: 120 IU/kg subcutaneously every 12 hours (max 10,000 IU per dose) with aspirin.
None Documented
None Documented
24–48 hours; prolonged in hepatic impairment or with CYP2C9 polymorphisms.
2-4 hours (anti-Xa activity) after subcutaneous administration; prolonged in renal impairment (creatinine clearance <30 mL/min: up to 6-12 hours)
Primarily renal as inactive metabolites; minimal biliary/fecal. ~95% renal, ~5% fecal.
Primarily renal excretion (up to 70% as unchanged drug via glomerular filtration); minor biliary/fecal elimination (<15%)
Category C
Category C
Anticoagulant
Anticoagulant