Share This Article:

Evaluation of a Dose-Monitoring Method for Prophylactic Anticoagulant Therapy with Low-Molecular-Weight Heparin

Abstract Full-Text HTML Download Download as PDF (Size:1765KB) PP. 429-434
DOI: 10.4236/ijcm.2011.24071    4,411 Downloads   7,438 Views   Citations

ABSTRACT

Objective: In the present study, we report on the results of our investigation of optimum dose monitoring using coagulation and fibrinolytic system indicators during obstetric prophylactic anticoagulant therapy with enoxaparin. Study Design: Of 103 cases of cesarean section performed at our hospital, 37 cases were selected for this study after obtain ing their consent for blood collection. Variables of the coagulation and fibrinolytic systems [anti-factor Xa activity, endogenous thrombin potential (ETP), prothrombin time (PT) or international normalized ratio (INR), activated partial thromboplastin time (APTT) and D-dimer levels] were determined. Results: In the 5-day administration group, the anti-factor Xa activitywas 0.0 U/ml on the postoperative day 1, increased to 0.05 U/ml ± 0.04 U/ml on the postoperative day 3, and mildly increased to 0.06 U/ml ± 0.05 U/ml on the postoperative day 5. On the other hand, the anti-factor Xa activity in the 3-day administration group was 0.0 U/ml on the postoperative day 1 (before enoxaparin administration), increased to 0.06 U/ml ± 0.05 U/ml on the postoperative day 3, and significantly decreased to 0.02 U/ml ± 0.03 U/ml on the postoperative day 5 (p = 0.003); thus, the pattern of change was significantly different from that in the 5-day administration group (p = 0.004). Enoxaparin administration did not result in any significant fluctuation of the ETP, and no significant difference was observed between the 5-day and 3-day administration groups. Conclusion: Enoxaparin administration was associated with increase of the anti-factor Xa activity, and prolonged administration led to more sustained increase of the activity.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

S. Makino, M. Sugimura, T. Yorifuji, T. Koshiishi, T. Tanaka and S. Takeda, "Evaluation of a Dose-Monitoring Method for Prophylactic Anticoagulant Therapy with Low-Molecular-Weight Heparin," International Journal of Clinical Medicine, Vol. 2 No. 4, 2011, pp. 429-434. doi: 10.4236/ijcm.2011.24071.

References

[1] Editorial Committee on Japanese Guideline for Prevention of Venous Thromboembolism, “Japanese Guideline for Prevention of Venous Thromboembolism, Guideline 1-19,” Medical Frontier International Limited, Tokyo, 2006.
[2] Agency for Health and Quality, “Reducing the risk of Thromboembolism during Pregnancy, Birth and the Puerperium,” Royal College of Obstetricians and Gynaecologists, London, Green-Top Guideline No. 37, 2009.
[3] C. M. Samama, “Venous Thromboembolism Prevention in Surgery and Obstetrics: Clinical Guidelines,” European Journal of Anaesthesiology, Vol. 23, No. 2, 2006, pp. 95-116.
[4] M. Blondon, A. Perrier, M. Nendaz, M. Righini, F. Boehlen, M. Boulvain and P. De Moerloose, “Thromboprophylaxis with Low-Molecular-Weight Heparin after Cesarean Delivery,” Journal of Thrombosis and Haemostasis, Vol. 103, No. 1, 2009, pp. 129-137. doi:10.1160/TH09-06-0349
[5] E. Forsnes, A. Occhino and R. Acosta, “Spontaneous Spinal Epidural Hematoma in Pregnancy Associated with Using Low Molecular Weight Heparin,” Obstetrics & Gynecology, Vol. 113, No. 2, 2009, pp. 532-533.
[6] J. I. Weitz, J. Hirsh and M. M. Samansa, “New Anticoagulant Drugs,” Chest, Vol. 126, No. S3, 2004, pp. 265- 286. doi:10.1378/chest.126.3_suppl.265S
[7] F. B. Robert, T. G. Eng, S. G. Alexander, M. W. Euan and A. B. Elizabeth, “A Randomized Double-Blind Placebo Controlled Trial of Low Molecular Weight Heparin as Prophylaxis in Preventing Venous Thrombolic Events after Cesarean Section: A Pilot Study,” British Journal of Obstetrics and Gynaecology, Vol. 108, No. 8, 2001, pp. 835-839.
[8] European Fraxiparin Study Group, “Comparison of a Low Molecular Weight and Unfractionated Heparin for the Prevention of Deep Vein Thrombosis in Patients Undergoing Abdominal Surgery,” British Journal of Surgery, Vol. 75, No. 11, 1988, p. 1058. doi:10.1002/bjs.1800751105
[9] M. Koller, U. Schoch, P. Buchmann, F. Largiader, A. von Falten and P. G. Frick, “Low Molecular Weight Heparin (Kabi 2165) as Thromboprophylaxis in Electine Visceral Surgery: A Randomized, Bouble-Blind Study Versus Unfractionated Heparin,” Journal of Thrombosis and Haemostasis, Vol. 56, 1986, p. 243.
[10] V. V. Kakkar, A. T. Cohen, R. A. Edmonson, M. J. Phillips, D. J. Cooper, S. K. Das, K. T. Maher, R. M. Sanderson, V. P. Ward and S. Kakkar, “Low Molecular Weight versus Standard Heparin for Prevention of venous Thromboembolism after Major Abdominal Surgery,” Lancet, Vol. 34, No. S4, 1993, pp. 259-265.
[11] N. S. Fox, S. K. Laughon, S. D. Bender, D. H. Saltzman and A. Rebarber, “Anti-factor Xa Plasma Levels in Pregnant Women Receiving Low Molecular Weight Heparin Thromboprophylaxis,” Obstetrics & Gynecology, Vol. 112, No. 4, 2008, pp. 884-889. doi:10.1097/AOG.0b013e31818638dc
[12] J. Ellison, A. J. Thompson, J. A. Conkie, F. McCall, D. Walker and A. Greer, “Thromboprophylaxis Following Cesarean Section—A Comparison of the Antithrombolic Properties of Three Low Molecular Weight Heparins-Dalteparin, Enozaparin and Tinzaparin,” Journal of Thrombosis and Haemostasis, Vol. 86, No. 6, 2001, pp. 1374-1378.

  
comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.