Anticoagulation With Fondaparinux for Hemodiafiltration in Patients With Heparin-Induced Thrombocytopenia: Dose-Finding Study and Safety Evaluation
Autor: | Pieter Evenepoel, Kathleen Claes, Björn Meijers, Elien Mahieu, Peter Verhamme, Marc Jacquemin, Dirk Kuypers, Anne-Marie Bogaert, Karel Op De Beek |
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Rok vydání: | 2013 |
Předmět: |
Maintenance dose
business.industry medicine.medical_treatment Biomedical Engineering Medicine (miscellaneous) Bioengineering General Medicine Heparin medicine.disease Fondaparinux Biomaterials Tolerability Pharmacokinetics Anesthesia Heparin-induced thrombocytopenia medicine Hemodialysis business medicine.drug Blood coagulation test |
Zdroj: | Artificial Organs. 37:482-487 |
ISSN: | 0160-564X |
Popis: | The optimal anticoagulation regimen for hemodialysis (HD) in patients with heparin-induced thrombocytopenia (HIT) has not been defined. Hemodiafiltration (HDF) adds a large convective component to HD, thereby changing the pharmacokinetics of most anticoagulants. Data on coagulation regimens for HDF are scant. We therefore aimed to study the feasibility, effectiveness, tolerability, and pharmacokinetics of fondaparinux anticoagulation in HDF. This was a prospective observational dose-finding study. Patients were started on fondaparinux at a dose of 0.05 mg/kg postdialysis body weight. Per protocol dose escalation was performed when significant clotting was observed and reduced when the anti-Xa activity postdialysis exceeded 0.4 IU/mL. Dose adjustments were made by steps of 0.01 mg/kg postdialysis weight. Anti-Xa activity was measured using a chromogenic method calibrated with low-molecular-weight heparin and validated against fondaparinux-calibrated anti-Xa activity. Four patients with HIT were followed for 160 sessions in total. At the end of the dose titration study, three patients ended at a maintenance dose of 0.03 mg/kg and one patient at 0.04 mg/kg of fondaparinux. Significant bleeding attributable to fondaparinux did not occur. The occurrence of clotting increased parallel to the reduction of fondaparinux dose, from 0/53 and 0/15 sessions at the higher doses (0.04 and 0.05 mg/kg) to 3/75 (4%) at 0.03 mg/kg and 1/17 (6%) at 0.02 mg/kg. Fondaparinux may be safely used and provides adequate anticoagulation for HDF in patients with HIT. We recommend to adjust dosage of fondaparinux to body weight and to initiate therapy at a dose of 0.03 mg/kg to prevent accumulation. Dose titration can be achieved by targeting postdialysis anti-Xa activity. |
Databáze: | OpenAIRE |
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