Supratherapeutic anticoagulation from low-molecular-weight heparin in lung transplant recipients.

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
Jonathan P SingerLorriana E Leard

Abstract

Venous thromboembolism (VTE) is common after lung transplantation. Enoxaparin is an approved therapy for VTE and anti-factor Xa level can be used to monitor enoxaparin activity. Some studies have demonstrated elevated anti-factor Xa levels are associated with an increased risk of hemorrhage. Having identified a high incidence of supratherapeutic anti-factor Xa levels in lung transplant recipients, we aimed to elucidate the relationship between enoxaparin dose and anti-factor Xa level in this patient population. We identified post-lung transplantation patients with VTE receiving therapeutic enoxaparin who had anti-factor Xa level measured. Standard enoxaparin dosing was defined as 0.9 to 1.1 mg/kg. After identifying a high incidence of supratherapeutic anti-factor Xa levels, we implemented "non-standard" dosing of 0.8 mg/kg. Multivariate linear regression analysis was used to examine the association between enoxaparin dose and anti-factor Xa level; age, body mass index (BMI) and creatinine clearance were included as covariates. In the cohort, 18 patients received standard and 8 patients received non-standard enoxaparin dosing. Twelve of 18 patients (67%; 95% confidence interval [CI]: 43% to 91%) receiving standard dosing had sup...Continue Reading

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Citations

Sep 17, 2013·Clinical Transplantation·Misbah A MotenSamir J Patel
Dec 17, 2014·Clinical and Applied Thrombosis/hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis·J Matt FreerMark S Thoelke
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Nov 5, 2013·Virulence·Birju A Shah, James F Padbury
Mar 5, 2021·Journal of Thrombosis and Thrombolysis·Christina C KaoAmit D Parulekar

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The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
Erika S KahanGerard J Criner
Journal of Perinatology : Official Journal of the California Perinatal Association
E Friedrich, A B Hameed
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