Abstract:

AIM: To analyze the asymmetric risk pattern of "controllable bleeding in prophylaxis versus suboptimal dosing in treatment" during dalteparin sodium use in orthopedic patients using a dual-scenario framework, providing insights for refined anticoagulation management. METHODS: This retrospective study included 200 inpatients receiving dalteparin sodium in an orthopedic department (September 2023 to March 2025). Patients were categorized into prophylaxis (n=185) and treatment (n=15) groups. Multivariate logistic regression identified bleeding risk factors in the prophylaxis group, with stratified analysis and propensity score matching (PSM) assessing potential confounding by indication. For the small treatment group, exploratory analyses (Fisher's exact test, Firth regression, Bayesian methods) were employed. RESULTS: In the prophylaxis group, bleeding events occurred in 22.70% of patients. A Caprini score ≥5 was an independent risk factor (OR=8.06, 95%CI: 1.79–36.20, P=0.007), while inappropriate dosing timing was associated with reduced bleeding risk (OR=0.14, 95%CI: 0.05–0.46, P=0.001). Stratified analysis and PSM suggested confounding by indication. In the treatment group, subtherapeutic dosing was observed in 93.33% of patients, with a 21.43% treatment failure rate. All failures occurred in the subtherapeutic dosing subgroup, though sample size limitations precluded definitive conclusions. CONCLUSION: Dalteparin sodium use in orthopedics shows a dual-scenario pattern: concentrated bleeding risk in prophylaxis and prevalent dosing deviations in treatment. A Caprini score ≥5 serves as a key bleeding risk indicator in prophylaxis. Failure to implement weight-stratified dosing may contribute to therapeutic failure. The proposed tiered pharmaceutical care framework offers practical guidance for optimizing dalteparin sodium use in orthopedic practice.

Key words: dalteparin sodium, orthopedics, bleeding events, treatment failure, real-world study