Document Detail


Analysis of unfractionated heparin dose requirements to target therapeutic anti-Xa intensity during pregnancy.
MedLine Citation:
PMID:  19699510     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Unfractionated heparin (UFH) does not cross the placenta and has demonstrated utility in the prevention and treatment of thrombosis during pregnancy. Limited information is available to guide initiation and monitoring of therapeutic UFH targeting an anti-Xa concentration of 0.3-0.7 u/ml during pregnancy. The objective of this study was to describe UFH doses and monitoring strategies required to achieve and maintain therapeutic anti-Xa intensity in a cohort of women treated with UFH during pregnancy. MATERIALS/METHODS: Patients prescribed anti-Xa adjusted UFH during pregnancies occurring between January 1998 and March 2005 were included. RESULTS: A total of 39 pregnancies for 37 women were identified. Unfractionated heparin doses were titrated to achieve a mid-interval anti-Xa level of 0.3-0.7 u/ml. Patients required a median 6.5 days and a mean UFH dose of 403.5 u/kg/day to achieve therapeutic anti-Xa levels. Most anti-Xa levels were within the target range (59%). The final UFH dose/kg required at the end of pregnancy was similar to that at the first therapeutic level (P>0.05); however some patients did require dose modification. Patients required a mean 14.1 anti-Xa determinations and 4.6 dose modifications during a mean 23.9 weeks of antenatal UFH therapy. Patient weight and UFH dose at the first therapeutic anti-Xa level were correlated (r=0.383, P=0.018). CONCLUSIONS: Pregnant women required a mean UFH dose of 403.5 u/kg/day to achieve midinterval anti-Xa levels of 0.3-0.7 u/ml. The required dose was correlated with patient weight and most anti-Xa measurements were within the target range.
Authors:
Nathan P Clark; Thomas Delate; Steven J Cleary; Daniel M Witt
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-08-21
Journal Detail:
Title:  Thrombosis research     Volume:  125     ISSN:  1879-2472     ISO Abbreviation:  Thromb. Res.     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-04-26     Completed Date:  2010-07-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0326377     Medline TA:  Thromb Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  402-5     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2009 Elsevier Ltd. All rights reserved.
Affiliation:
Clinical Pharmacy Anticoagulation Service, Kaiser Permanente Colorado, 280 Exempla Circle, Lafayette, Colorado, USA. nathan.clark@kp.org
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MeSH Terms
Descriptor/Qualifier:
Adult
Anticoagulants / administration & dosage
Dose-Response Relationship, Drug
Drug Delivery Systems / methods
Drug Monitoring / methods*
Factor Xa / analysis,  antagonists & inhibitors*
Female
Heparin / administration & dosage*
Humans
Pregnancy / blood*,  drug effects*
Pregnancy Complications, Cardiovascular / blood*,  prevention & control
Retrospective Studies
Thrombosis / blood*,  prevention & control
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anticoagulants; 9005-49-6/Heparin; EC 3.4.21.6/Factor Xa

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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