Document Detail


A prospective trial that demonstrates that dalteparin requirements increase in pregnancy to maintain therapeutic levels of anticoagulation.
MedLine Citation:
PMID:  15467584     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The purpose of this study was to determine whether standard therapeutic doses of dalteparin maintain peak therapeutic levels of anticoagulation during pregnancy. STUDY DESIGN: This was a prospective trial in which 13 pregnancies that required therapeutic anticoagulation were treated with dalteparin 100 U/kg every 12 hours; peak and trough (predose) low molecular weight heparin (anti-Xa activity) levels were monitored every 2 weeks. Dosage adjustments were made to maintain peak anti-Xa activity between 0.5 and 1.0 IU/ml. Bone density and bone turnover markers were measured. RESULTS: A total of 250 peak and trough low-molecular-weight heparin (LMWH) levels were obtained. Eighty-five percent of pregnancies (11/13) required an upward dosage adjustment. Trough levels were in the therapeutic range only 9% of the time, despite the maintenance of therapeutic peak levels. Bone resorption markers and density were unchanged in singleton pregnancies. CONCLUSION: Dalteparin dosing, based on weight alone, every 12 hours is inadequate to maintain most pregnant women in the therapeutic range throughout pregnancy as measured by anti-Xa activity. Trough levels are rarely in the therapeutic range, despite maintenance of therapeutic peak levels. These notable changes in low molecular weight heparin peak may explain reported failures in pregnancy.
Authors:
Linda A Barbour; Janet L Oja; Lisa K Schultz
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  191     ISSN:  0002-9378     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2004 Sep 
Date Detail:
Created Date:  2004-10-06     Completed Date:  2004-11-06     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1024-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, University of Colorado Health Sciences Center, Denver, USA.
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MeSH Terms
Descriptor/Qualifier:
Abortion, Spontaneous / epidemiology
Adult
Anticoagulants / administration & dosage*
Dalteparin / administration & dosage*,  blood
Dose-Response Relationship, Drug
Female
Heparin, Low-Molecular-Weight / administration & dosage,  blood
Humans
Pregnancy
Pregnancy Complications, Cardiovascular / drug therapy*
Pregnancy Outcome
Prospective Studies
Venous Thrombosis / drug therapy*
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Dalteparin; 0/Heparin, Low-Molecular-Weight

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


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