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

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:29

Article

Singer, Jonathan P.¹  Huang, Meng-Yu²  Hui, Christine²  Blanc, Paul D.¹  Boettger, Rebecca F.²  Golden, Jeffery¹  Watkins, Katherine²  Hoopes, Charles³  Leard, Lorriana E.¹ 

[1] Univ Calif San Francisco, Div Pulm & Crit Care Med, Dept Med, San Francisco, CA 94143 USA

[2] Univ Calif San Francisco, Dept Clin Pharm, San Francisco, CA 94143 USA

[3] Univ Calif San Francisco, Div Cardiothorac Surg, Dept Surg, San Francisco, CA 94143 USA

关键词: lung transplantation;    venous thromboembolism;    anticoagulation;    enoxaparin;    deep venous thrombosis;    pulmonary embolism;   

DOI  :  10.1016/j.healun.2010.04.018

来源: Elsevier

【 摘 要 】

BACKGROUND: 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. METHODS: 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 nonstandard 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. RESULTS: 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 supratherapeutic anti-factor Xa levels vs 0 of 8 patients. (0%; 95% CI: 0% to 37%) receiving lower non-standard dosing (p = 0.092). Anti-factor Xa levels were significantly different between the two groups; the mean anti-factor Xa level was 1.3 IU/ml (95% CI: 1.06 to 1.53) in the standard group vs 0.79 IU/ml (95% CI: 0.67 to 0.91) in the non-standard group (p = 0.008). After controlling for covariates, for each 0.1-mg/kg increase in enoxaparin, the mean anti-factor Xa level increased by 0.18 IU/ml (95% CI: 0.05 to 0.31; p = 0.011; model r(2) = 0.53). CONCLUSIONS: Standard dosing of enoxaparin in lung transplant recipients is associated with a high incidence of supratherapeutic anti-Xa levels. Further study will be required to correlate this finding with risk of hemorrhage. J Heart Lung Transplant 2010;29:1009-13 (C) 2010 International Society for Heart and Lung Transplantation. All rights reserved.

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