Download PDF
Semin Thromb Hemost 2001; 27(5): 519-522
DOI: 10.1055/s-2001-17961
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

How and When to Monitor a Patient Treated with Low Molecular Weight Heparin

Bernard Boneu1 , Philippe de Moerloose2
  • 1Laboratoire d'Hématologie, Hôpital de Rangueil, Toulouse, France
  • 2Laboratoire d'Hémostase, Hôpital Cantonal, Geneva, Switzerland
Further Information

Publication History

Publication Date:
22 October 2001 (online)

    Permissions and Reprints

ABSTRACT

Low molecular weight heparins (LMWHs) are as efficient as unfractionated heparin (UFH) for prevention and treatment of thromboembolism. There is no evidence that monitoring the dose improves the clinical efficacy. In contrast, any overdosage increases the risk of hemorrhage. Because renal function plays a significant role in the elimination of LMWH, curative treatment should be monitored with an anti-factor Xa assay in patients presenting renal insufficiency, in the elderly, and in patients presenting an increased hemorrhagic risk. It is advisable to sample the patient at peak activity (3 to 5 hours after the subcutaneous [sc] administration) and to target the mean anti-factor Xa activity that was found efficient and safe in the clinical trial. This target is different for each LMWH and each dose regimen.

KEYWORD

Low molecular weight heparin (LMWH) - thrombosis - pulmonary embolism - renal function - bleeding - prevention - treatment

REFERENCES

  • 1 Leizorovicz A, Simmonneau G, Decousus J, Boissel J P. Comparison of efficacy and safety of low molecular weight heparins and unfractionated heparin in initial treatment of deep venous thrombosis: a meta-analysis.  BMJ . 1994;  309 299-304
    PubMedSearch in Google Scholar
  • 2 Lensing A WA, Prins M H, Davidson B L, Hirsh J. Treatment of deep venous thrombosis with low-molecular-weight heparins.  Arch Intern Med . 1995;  155 601-607
    CrossrefPubMedSearch in Google Scholar
  • 3 Simmonneau G, Sors H, Charbonnier B. A comparison of low-molecular-weight heparin with unfractionated heparin for acute pulmonary embolism.  N Engl J Med . 1997;  337 663-669
    CrossrefPubMedSearch in Google Scholar
  • 4 The Columbus Investigators. Low-molecular-weight heparin in the treatment of patients with venous thromboembolism.  N Engl J Med . 1997;  337 657-662
    CrossrefPubMedSearch in Google Scholar
  • 5 Swahn E, Wallentin L. Low molecular weight heparin (Fragmin) during instability in coronary artery disease (FRISC).  Am J Cardiol . 1997;  80 25-29
    CrossrefPubMedSearch in Google Scholar
  • 6 Klein W, Buchwald A, Hillis S E. Comparison of low molecular weight heparin with unfractionated heparin acutely and with placebo for 6 weeks in the management of unstable coronary artery disease: Fragmin in unstable coronary disease study (FRISC).  Circulation . 1997;  96 61-68
    PubMedSearch in Google Scholar
  • 7 Cohen M, Demers C, Gurfinkel E P. A comparison of low molecular weight heparin with unfractionated heparin for unstable coronary artery disease.  N Engl J Med . 1997;  337 447-452
    CrossrefPubMedSearch in Google Scholar
  • 8 Levine M, Gent M, Hirsh J. A comparison of low-molecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep-vein thrombosis.  N Engl J Med . 1996;  334 677-681
    CrossrefPubMedSearch in Google Scholar
  • 9 Koopman M MW, Prandoni P, Piovella F, Ockelford P A. Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low-molecular-weight heparin administered at home.  N Engl J Med . 1996;  334 682-687
    CrossrefPubMedSearch in Google Scholar
  • 10 Alhenc-Gelas M, Le Guernic J, Vitoux J F. Adjusted versus fixed doses of the low-molecular-weight heparin Fragmin℗ in the treatment of deep vein thrombosis.  Thromb Haemost . 1994;  71 698-702
    PubMedSearch in Google Scholar
  • 11 Carter C J, Kelton J G, Hirsh J. The relationship between the hemorrhagic and antithrombotic properties of low molecular weight heparin in rabbits.  Blood . 1992;  59 1239-1245
    PubMedSearch in Google Scholar
  • 12 Leizorovicz A, Simmonneau G, Decousus H. Comparison of low molecular weight heparin and unfractionated heparin in the treatment of DVT: a metaanalysis.  Thromb Haemost . 1993;  69 647(Abst)
    PubMedSearch in Google Scholar
  • 13 Thomas D P. Does low molecular weight heparin cause less bleeding.  Thromb Haemost . 1997;  78 1422-1425
    PubMedSearch in Google Scholar
  • 14 Boneu B, Caranobe C, Saivin S, Dol F, Sié P. Pharmacokinetics of heparin and of dermatan sulfate: clinical implications.  Adv Exp Med Biol . 1992;  313 237-247
    PubMedSearch in Google Scholar
  • 15 Goudable C, Saivin S, Houin G. Pharmacokinetics of a low molecular weight heparin (Fraxiparin℗) in various stages of chronic renal failure.  Nephron . 1991;  59 543-545
    PubMedSearch in Google Scholar
  • 16 Cadroy Y, Pourrat J, Baladre M F. Delayed elimination of enoxaparin in patients with chronic renal insufficiency.  Thromb Res . 1991;  63 385-390
    CrossrefPubMedSearch in Google Scholar
  • 17 Mismetti P, Laporte-Simitsidis S, Navarro C. Aging and venous thromboembolism influence of pharmacodynamics of the anti-Xa and anti-IIa activities of a low molecular weight heparin (nadroparin).  Thromb Haemost . 1998;  79 1162-1165
    PubMedSearch in Google Scholar
  • 18 Siguret V, Pautas E, Fevrier M. Elderly patients treated with tinzaparin (Innohep℗) administered once daily (175 anti-Xa U/kg): anti-Xa and anti-IIa activities over 10 days.  Thromb Haemost . 2000;  84 800-804
    PubMedSearch in Google Scholar
  • 19 Hemker H C, Beguin S. Thrombin generation in plasma: its assessment via the endogenous thrombin potential.  Thromb Haemost . 1995;  74 134-138
    PubMedSearch in Google Scholar
  • 20 Boneu B, Faruel-Bille V, Pierrejean D, Gabaig A M. Limitations of the chronometric assays to determine plasma antifactor Xa activity during low molecular weight heparin therapy.  Nouv Rev Fr Hematol . 1991;  33 287-291
    PubMedSearch in Google Scholar
  • 21 Barrowcliffe T W, Curtis A, Johnson E, Thomas D P. An international standard for low molecular weight heparin.  Thromb Haemost . 1988;  60 1-7
    PubMedSearch in Google Scholar
  • 22 Sié P, Aillaud M F, de Prost D. Measurement of low molecular weight heparin ex vivo activities in clinical laboratories using various anti-Xa assays, interlaboratory variability and requirement of an agreed low molecular weight heparin standard.  Thromb Haemost . 1987;  58 879-883
    PubMedSearch in Google Scholar
  • 23 Boneu B, Navarro C, Cambus J P. Pharmacodynamics and tolerance of two nadroparin formulations (10250 and 20500 anti-Xa IU/ml-1) delivered for 10 days at therapeutic dose.  Thromb Haemost . 1998;  79 338-341
    PubMedSearch in Google Scholar
  • 24 The DVTENOX Study Group. Markers of hemostatic system activation in acute deep venous thrombosis-evolution during the first days of heparin treatment.  Thromb Haemost . 1993;  70 909-914
    PubMedSearch in Google Scholar