Abstract | BACKGROUND: 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 "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. 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 = 0.002). 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.
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Authors | Jonathan P Singer, Meng-Yu Huang, Christine Hui, Paul D Blanc, Rebecca F Boettger, Jeffery Golden, Katherine Watkins, Charles Hoopes, Lorriana E Leard |
Journal | The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
(J Heart Lung Transplant)
Vol. 29
Issue 9
Pg. 1009-13
(Sep 2010)
ISSN: 1557-3117 [Electronic] United States |
PMID | 20627627
(Publication Type: Journal Article)
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Copyright | Copyright 2010 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved. |
Chemical References |
- Anticoagulants
- Enoxaparin
- Heparin, Low-Molecular-Weight
- Immunosuppressive Agents
- Creatinine
- Factor Xa
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Topics |
- Adult
- Aged
- Anticoagulants
(therapeutic use)
- Creatinine
(metabolism)
- Enoxaparin
(therapeutic use)
- Factor Xa
(analysis, immunology)
- Female
- Heparin, Low-Molecular-Weight
(therapeutic use)
- Humans
- Immunosuppressive Agents
(therapeutic use)
- Lung Transplantation
(adverse effects, immunology, methods)
- Male
- Middle Aged
- Postoperative Complications
(diagnosis)
- Prothrombin Time
- Pulmonary Embolism
(diagnosis)
- Ultrasonography
- Venous Thrombosis
(diagnostic imaging)
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