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Thromb Haemost 2005; 93(06): 1185-1188
DOI: 10.1160/TH05-01-0052
Cellular Proteolysis and Oncology
Schattauer GmbH

Anti-Xa effect of a low molecular weight heparin (dalteparin) does not accumulate in extended duration therapy for venous thromboembolism in cancer patients

Michael J. Kovacs
1   London Health Sciences Centre, London, Ontario, Canada
,
Mark N. Levine
2   Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
,
Michael Keeney
1   London Health Sciences Centre, London, Ontario, Canada
,
Karen M. MacKinnon
1   London Health Sciences Centre, London, Ontario, Canada
,
Agnes Y. Lee
2   Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
› Author Affiliations
Further Information

Publication History

Received 21 January 2005

Accepted after revision 17 March 2005

Publication Date:
11 December 2017 (online)

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Summary

Many patients with venous thromboembolism are being treated with low molecular weight heparin for extended periods of time. It is not certain if it is necessary to assess anti-Xa levels for extended treatment periods. This study is a prospective assessment of anti-Xa levels in patients on long-term therapy for acute venous thromboembolism who have active cancer. Consecutive consenting patients from one center in a multicenter trial that compared 6 months of low molecular weight heparin with oral anticoagulant therapy were treated with therapeutic doses of dalteparin (200 IU per kilogram) subcutaneously daily. Anti-Xa levels were assessed at the end of weeks 1 and 4, 4–6 hours after injection of dalteparin. Patients were followed for bleeding and recurrent venous thromboembolism. There were 24 patients who had anti-Xa levels measured at weeks 1 and 4. Two other patients had week 1 measurements performed but died before the week 4 sample was collected due to their underlying cancer. The mean anti-Xa levels at weeks 1 and 4 were 1.11 and 1.03 anti-Xa units/ml respectively (P=0.13). These results suggest that for patients with active cancer receiving extended duration therapy with low molecular weight heparin (dalteparin) there is no accumulation of anti-Xa effect over the first month of therapy. Monitoring of anti-Xa levels in this situation is usually not required.

Keywords

Low molecular weight heparin - anti-Xa levels - VTE - cancer
 

  • References

  • 1 Hyers TM, Agnelli G, Hull RD. et al Antithrombotic therapy for venous thromboembolic disease. Chest 2001; 119 (Suppl. 01) 176S-193S.
    CrossrefPubMedGoogle Scholar
  • 2 The Columbus Investigators Low-molecularweight heparin in the treatment of patients with venous thromboembolism. N Engl J Med 1997; 337: 657-62.
    CrossrefPubMedGoogle Scholar
  • 3 Lee AY, Levine MN, Baker RI. et al Low-molecular- weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 2003; 349: 146-53
    CrossrefPubMedGoogle Scholar
  • 4 Levine M, Gent M, Hirsch J. et al A comparison of low-molecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep-vein thrombosis. N Engl J Med 1996; 334: 667-81
    PubMedGoogle Scholar
  • 5 Wells PS, Kovacs MJ, Bormanis J. et al Expanding eligibility for outpatient treatment of deep venous thrombosis and pulmonary embolism with low-molecular- weight heparin: a comparison of patient self-in- jection with homecare injection. Arch Intern Med 1998; 158: 1809-12
    CrossrefPubMedGoogle Scholar
  • 6 Greaves M. Limitations of the laboratory monitoring of heparin therapy. Scientific and Standardization Committee Communications: on behalf of the Control of Anticoagulation Subcommittee of the Scientific and Standardization Committee of the International Society of Thrombosis and Haemostasis. Thromb Haemost 2002; 87: 163-4
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Prandoni P, Lensing AW, Piccioli A. et al Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 2002; 100: 3484-88
    CrossrefPubMedGoogle Scholar
  • 8 Siguret V, Pautas E, Fevrier M. et al Elderly patients treated with tinzaparin (Innohep) administered once daily (175 anti-Xa IU/kg): anti-Xa and anti-IIa activities over 10 days. Thromb Haemost 2000; 84: 800-04
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Mismetti P, Laporte-Simitsidis S, Navarro C. et al Aging and venous thromboembolism influence the pharmacodynamics of the anti-factor Xa and anti-thrombin activities of a low molecular weight heparin (nadroparin). Thromb Haemost 1998; 79: 1162-65.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Hirsh J, Warkentin TE, Shaughnessy SG. et al Heparin and low-molecular-weight heparin: mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy, and safety. Chest 2001; 119: 64S-94S.
    CrossrefPubMedGoogle Scholar
  • 11 Nagge J, Crowther M, Hirsh J. Is impaired renal function a contraindication to the use of low-molecular- molecular- weight heparin?. Arch Intern Med 2002; 162: 2605-9
    CrossrefPubMedGoogle Scholar
  • 12 Kitchen S, Iampietro R, Woolley AM. et al Anti Xa monitoring during treatment with low molecular weight heparin or danaparoid: inter-assay variability. Thromb Haemost 1999; 82: 1289-93
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Kovacs MJ, Keeney M, MacKinnon K. et al Three different chromogenic methods do not give equivalent anti-Xa levels for patients on therapeutic low molecular weight heparin (dalteparin) or unfractionated heparin. Clin Lab Haematol 1999; 21: 55-60
    CrossrefPubMedGoogle Scholar