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Anti-Xa activities following 5,000 IU and 7,500 IU of s.c. dalteparin in critically ill patients and 5,000 IU in medical patients: a prospective randomized study

Introduction

Unfractionated heparin is preferred over LMWH in ICU patients but LMWH is used more frequently in many European ICUs. Thromboprophylaxis with standard doses of nadroparin and enoxaparin has been shown to result in significantly lower anti-Xa in ICU patients when compared with medical patients [1, 2].

Methods

ICU patients (SAPS 44 ± 16, MV, n = 44; pressors n = 32) received 7,500 IU (Group 1, n = 25) or 5,000 IU dalteparin s.c. (Group 2, n = 29). Twenty-nine medical patients receiving 5,000 IU dalteparin served as controls (Group 3).

Results

Group 2 had significantly lower areas under the Xa curve (AUC) compared with Groups 1 and 3 (Table 1). Differences were not significant between Groups 1 and 3. Peak anti-Xa activities (Cmax-anti-Xa) were delayed (tmax-anti-Xa) in Group 2 compared with Groups 1 and 3 (Table 1).

Table 1 Pharmacokinetics

Conclusion

In ICU patients a s.c. dose of 5,000 IU dalteparin results in significantly lower Xa activities when compared with normal ward patients. A s.c. dose of 7,500 IU dalteparin in ICU patients resulted in kinetics and peak anti-Xa activities comparable with medical patients receiving 5,000 IU dalteparin.

References

  1. 1.

    Dörffler-Melly J, deJonge E, dePont AC, et al.: Bioavailability of subcutaneous low-molecular-weight heparin to patients on vasopressors. Lancet 2002, 359: 849-850. 10.1016/S0140-6736(02)07920-5

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    Priglinger U, Delle Karth G, Geppert A, et al.: Prophylactic anticoagulation with enoxaparin: is the subcoutaneous route appropriate in the critically ill? Crit Care Med 2003, 31: 1405-1409. 10.1097/01.CCM.0000059725.60509.A0

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Correspondence to GH Heinz.

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Heinz, G., Priglinger, U. & Pabinger, I. Anti-Xa activities following 5,000 IU and 7,500 IU of s.c. dalteparin in critically ill patients and 5,000 IU in medical patients: a prospective randomized study. Crit Care 17, P351 (2013). https://doi.org/10.1186/cc12289

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Keywords

  • Public Health
  • Heparin
  • Emergency Medicine
  • Standard Dose
  • Enoxaparin