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anti-Xa Levels (anti-xa + level)
Selected AbstractsInadvertent postdialysis anticoagulation due to heparin line locksHEMODIALYSIS INTERNATIONAL, Issue 4 2007Ruth J. PEPPER Abstract Large-bore dual lumen in-dwelling venous catheters are used in hemodialysis. These catheters are usually locked with heparin after the treatment. This study addressed the underappreciated postdialysis coagulopathy that can result. Thirty-six patients were included: 7 dialyzed through arterio-venous fistulae, 29 through in-dwelling venous catheters. The latter group was further subdivided according to whether they received heparin or heparin-free dialysis. To assess the heparin lock, a full-dose heparin lock as well as a much weaker heparin lock and a citrate lock were used. To assess the coagulopathy, blood was taken 1 hr after dialysis. The activated partial thromboplastin time (APTT) and anti-Xa level was measured. Additionally, 6 venous catheters were removed and the amount of fluid expelled upon locking with saline was measured. Clotting from the patient group with arterio-venous fistulae was normal following dialysis. The patients with in-dwelling venous catheters and heparin locks had significantly deranged clotting; 6 out of 10 patients had abnormal APTT results. All patients with catheters, heparin-free dialysis, and heparin locks had deranged clotting (7 out of 7). The rate decreased significantly when heparinized saline was used as a lock. A subset of patients had a citrate lock rather than a heparin lock; the clotting results normalized in all but one patient. An in vitro study demonstrated immediate leakage of fluid from the end of the ports upon locking. Significant postdialysis anticoagulation can occur after dialysis, which can be attributed to the heparin line locks. This risk is considerably reduced when a citrate lock is used instead. [source] Study of bioaccumulation of dalteparin at a prophylactic dose in patients with various degrees of impaired renal functionJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 4 2009P. SCHMID Summary.,Background: Low-molecular-weight heparins (LMWH) have been shown to be effective and safe for prophylaxis of thromboembolic diseases. However, issues regarding safety and optimal use of LMWH arise in patients with renal insufficiency (RI). Objectives: To compare pharmacokinetic data of dalteparin for up to 3 weeks in patients with various degrees of RI. Patients and methods: Patients from general medical and surgical wards were included in this prospective cohort study and divided into three groups according to renal function: A = normal (GFR , 60 mL min,11.73 m,2), B = mild RI (GFR 30,59 mL min,11.73 m,2), C = severe RI (GFR < 30 mL min,11.73 m,2). Dalteparin was injected s.c. once daily at a prophylactic dose. Peak anti-Xa activity levels (anti-Xa) were measured 4 ± 1 h after injection on day 1 and every third day up to 3 weeks. Primary objectives were peak anti-Xa levels and adjusted anti-Xa levels, adjustment being carried out for dose and body weight. Results: A total of 42 patients could be analyzed during a median of 10 days (interquartile range IQR 4,13, range 1,20). In all groups, adjusted peak anti-Xa levels were not different on day 10 compared with day 1. No bioaccumulation >30% could be found up to day 10 even in patients with severe RI. Conclusion: The use of dalteparin at a prophylactic dose was not associated with a bioaccumulation >30% even in patients with severe renal insufficiency during a median follow-up of 10 days (IQR 4,13, range 1,20). [source] Maternal complications and pregnancy outcome in women with mechanical prosthetic heart valves treated with enoxaparinBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2009C McLintock Objective, To determine maternal and fetal outcomes in women with mechanical heart valves managed with therapeutic dose enoxaparin during pregnancy. Design, Retrospective audit. Setting, Hospital-based high-risk antenatal clinics. Population, Pregnant women with mechanical heart valves attending high-risk antenatal clinics, treated with enoxaparin (1 mg/kg twice daily) during pregnancy. Methods, Women with mechanical heart valves treated with enoxaparin at any stage during pregnancy (1997,2008) identified using a database of women with mechanical heart valves attending the high-risk clinics and a prospective database of women prescribed enoxaparin for any indication during pregnancy. Main outcome measures, Maternal outcomes included thromboembolic and haemorrhagic complications. Pregnancy and fetal outcomes included miscarriage, stillbirth, baby death and live birth, small-for-gestational-age infants, warfarin embryopathy and warfarin-related fetal loss. Results, Thirty-one women underwent 47 pregnancies. In 34 pregnancies (72.3%), anticoagulation was with predominantly enoxaparin and 13 (27.7%) pregnancies women received mainly warfarin, with enoxaparin given in the first trimester and/or peri-delivery. Seven (14.9%) thrombotic complications occurred, of which five (10.6%) were associated with enoxaparin treatment. Non-compliance or sub-therapeutic anti-Xa levels contributed in each case. Antenatal and postpartum haemorrhagic complications occurred in eight (17%) and 15 (32%) pregnancies respectively. Of 35 pregnancies continuing after 20 weeks' gestation, 96% (22/23) of women taking predominantly enoxaparin had a surviving infant compared with 75% (9/12) in women taking primarily warfarin. Four perinatal deaths occurred, three attributable to warfarin. Conclusions, Compliance with therapeutic dose enoxaparin and aspirin during pregnancy in women with mechanical heart valves is associated with a low risk of valve thrombosis and good fetal outcomes, but close monitoring is essential. [source] | ||||||||||