1. Anti-Xa Levels in Critically Ill Patients Receiving Dalteparin for Thromboprophylaxis
- Author
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Tracy McCardle, Mark Crowther, Deborah J. Cook, Carson Davidson, Julia Foxall, Christine Wynne, Kim Bouwers, Andrea McNeill, Lauren Griffith, Susan Pleasance, Ellen McDonald, Geneviève Larouche, Nicole Zytaruk, Mark Duffett, Johanne Harvey, Anik Rioux, Irene Watpool, Craig Dale, Mary Jo, and Louise Provost
- Subjects
medicine.medical_specialty ,medicine.drug_class ,business.industry ,Critically ill ,Immunology ,Low molecular weight heparin ,Renal function ,Cell Biology ,Hematology ,Biochemistry ,Group B ,Surgery ,Increased risk ,Anesthesia ,Orthopedic surgery ,medicine ,In patient ,Neurosurgery ,business - Abstract
Rationale: Despite the efficacy and safety of low molecular weight heparin (LWMH) compared to unfractionated (UFH) in many patients, LMWH may bioaccumulate in patients with renal insufficiency which could cause an increased risk of bleeding. If LMWH thromboprophylaxis is safe in ICU patients with renal insufficiency, this could reduce the risk of DVT and HIT. Since the extent to which LMWH bioaccumulates in critically ill patients in prophylactic rather than therapeutic doses is unclear, our objective was to measure peak and trough anti-Xa levels during a multicenter randomized pilot trial of LMWH vs UFH for thromboprophylaxis in the medical-surgical ICU setting. Methods: We included 128 patients ≥18 years with an expected ICU stay ≥72h. We excluded patients with trauma, orthopedic, cardiac, or neurosurgery, severe hypertension, DVT, PE or hemorrhage within 3 mos, INR >2ULN, PTT >2ULN, platelets Results: No differences were found in the 2 groups (median anti-Xa levels) as shown below. Conclusions: We did not observe LWMH or UFH bioaccumulation when administered in prophylactic doses in these critically ill patients with a range of renal dysfunction. Anti-Xa Levels Allocation Cr Cl
- Published
- 2004