Pathophysiology of Haemostasis and Thrombosis

Original Paper

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Effect of Patient Weight on the Anticoagulant Response to Adjusted Therapeutic Dosage of Low-Molecular- Weight Heparin for the Treatment ofVenous Thromboembolism

Wilson S.J-A.a · Wilbur K.d · Burton E.b · Anderson D.R.c

Author affiliations

aFaculty of Health Professions, Dalhousie University, and Pharmacy Department, bData Base Department and cDepartment of Medicine, Division of Hematology, Queen Elizabeth II Health Sciences Centre, Halifax, N.S., and dFaculty of Pharmaceutical Sciences, University of British Columbia and Vancouver Hospital and Health Sciences Centre, Vancouver, B.C., Canada

Corresponding Author

Dr. S. Jo-Anne Wilson, Queen Elizabeth II Health Sciences Centre

Pharmacy Department – Victoria General, Room 2043 Victoria

Halifax, NS B3H 2Y9 (Canada)

Tel. +1 902 473 6600, Fax +1 902 473 6812

E-Mail RXJSW@qe2-hsc.ns.ca

Keywords: Low-molecular-weight heparinAnti-Xa levelsVenous thromboembolism

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Haemostasis 2001;31:42–48
https://doi.org/10.1159/000048043

Abstract

Data evaluating the safety of using weight-based dosing of low-molecular-weight heparin (LMWH) in obese patients are limited. Some manufacturers have recommended a maximum daily dose of LMWH not to be exceeded. The purpose of this study was to determine if body weight influenced the anticoagulant response to a weight-based dose of LMWH for the treatment of venous thromboembolism. Patients with serum creatinine levels <150 µmol/l receiving the LMWH , dalteparin 200 anti-Xa IU/kg based on actual body weight subcutaneously once daily for the treatment of deep vein thrombosis or pulmonary embolism, were eligible for the study. Patients received a minimum of 5 days LMWH treatment. Patients had peak anti-Xa levels (IL Test Chromogenic assay) measured 3–4 h following their day 3 injection and trough anti-Xa levels measured immediately prior to injections on day 3 and 5. No dose adjustments were made on the basis of the anti-Xa levels. Patients were a priori stratified into three weight classes: (A) within 20% of ideal body weight (IBW) (n = 13); (B) 20–40% of IBW (n = 14), and (C) greater than 40% of IBW (n = 10). The largest patient weighed 190 kg and had a body mass index of 58. Mean daily LMWH doses were 14,030, 17,646 and 23, 565 IU for groups A, B and C, respectively. Mean (SD) trough anti-Xa levels on day 3 were 0.12 (0.05) anti-Xa IU/ml for group A, 0.11 (0.03) anti-Xa IU/ml for group B and 0.11 (0.03) anti-Xa IU/ml for group C (p > 0.2). Similar trough anti-Xa levels were observed on day 5. Mean (SD) peak anti-Xa levels on day 3 were 1.01 (0.20) anti-Xa IU/ml, 0.97 (0.21) anti-Xa IU/ml and 1.12 (0.22) anti-Xa IU/ml for groups A, B and C, respectively (p > 0.2). No thromboembolic or bleeding complications occurred during LMWH therapy in any patients. These findings suggest that body mass does not appear to have an important effect on the response to LMWH up to a weight of 190 kg in patients with normal or near normal renal function.

© 2001 S. Karger AG, Basel



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Article / Publication Details

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Abstract of Original Paper

Published online: June 15, 2001
Issue release date: June 2001

Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 2

ISSN: 1424-8832 (Print)
eISSN: 1424-8840 (Online)

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2001, Vol.31, No. 1

June 2001

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