A multi-dose pharmacokinetic study of dalteparin in haemodialysis patients

Stephanie L. Perry; Susan I. O’Shea; Stephen Byrne; Lynda A. Szczech; Thomas L. Ortel

doi:10.1160/TH06-01-0006

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2006; 96(06): 750-755
DOI: 10.1160/TH06-01-0006

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

A multi-dose pharmacokinetic study of dalteparin in haemodialysis patients

Stephanie L. Perry^*

¹Division of Hematology, Duke University Health System, Durham, North Carolina, USA

,

Susan I. O’Shea^*

⁴Department of Hematology Cork, University Hospital and the College, Cork, Ireland

⁵School of Pharmacy, University College, Cork, Ireland

,

Stephen Byrne

⁵School of Pharmacy, University College, Cork, Ireland

,

Lynda A. Szczech

²Nephrology in the Department of Medicine, Duke University Health System, Durham, North Carolina, USA

,

Thomas L. Ortel

¹Division of Hematology, Duke University Health System, Durham, North Carolina, USA

³Pathology, Duke University Health System, Durham, North Carolina, USA

› Author Affiliations

Abstract

Summary

Low-molecular-weight heparins undergo renal elimination, and therefore the proper dosing in hemodialysis (HD) patients is unclear. It was the objective of this study to evaluate the pharmacokinetic (PK) parameters of dalteparin in patients receiving chronic HD for end-stage renal disease. We performeda multidose PK study with prophylactic doses of dalteparin in twelve HD patients. Dalteparin 5,000 IU was administered subcutaneously daily for four consecutive days, with HD performed on day2 and day 4. Anti-factor Xa activity was determined daily and at multiple blood samples after the 3^rd and 4^th dose. Eleven of 12 patients completed the study. The mean (range) PK parameters determined after the 4^th dose were as follows: i) maximum concentration (C_max) was 0.31 IU/ml (0.06 to 0.55 IU/ml); ii) time to C_max was 3.55 hours (2.59 to 4.96 hr); iii) area under the curve was 3.24 IU*hr/ml (0.64 to 6.44 IU*hr/ml); iv) half-life was 3.82 hr (2.03 to 9.63 hr); and v) trough anti-factor Xa activity 0.04 IU/ml (0.02 to 0.08 IU/ml). No major bleeding was observed. In general, patients with lower body weight exhibited a higher C_max. From this pilot PK study, we have determined initial PK parameters for dalteparin in HD patients. Although a standard prophylactic dose was used, we found that in this patient population differences in body weight influenced the C_max. Future studies to evaluate the PK parameters of dalteparin in patients receiving chronic HD may have to use weight-based dosing and will need to be performed over a longer period of time.

Keywords

Dalteparin - hemodialysis - low-molecular-weight heparin - pharmacokinetics

Full Text

References

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