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Table 1 Key points about monitoring of unfractionated heparin, low molecular weight heparins and fondaparinux[78, 162]

From: Measurement of non-VKA oral anticoagulants versus classic ones: the appropriate use of hemostasis assays

  Indications Posology and route of administration Delay for blood sampling Anti-Xa activity (IU/mL) aPTT
Unfractionated heparin
Sodium heparin -Prevention of clotting during hemodialysis Bolus of 1,000 - 5,000 IU followed by 1,000 - 2,000 IU per hour The sampling is performed whatever the time in case of IV perfusion, preferably 4 to 6h after each dosage variation. 0.3 to 0.7 1.5 to 3.0 – 8.0 the upper limit of normal depending on the reagent
-Cardiopulmonary bypass 300 units/kg intravenously, adjusted thereafter to maintain the activated clotting time (ACT) in the range 300-400 seconds  
Calcium heparin -Prevention of clotting during hemodialysis Loading dose of 1,000-5,000 units followed by 1,000-2,000 units/hour Part-time between 2 injections (6h after injection for a 2 injections/day) or 4h after injection for a 3 injections/day
-Cardiopulmonary bypass 300 units/kg intravenously, adjusted thereafter to maintain the activated clotting time (ACT) in the range 300-400 seconds  
Low molecular weight heparins: 2 injections per day†
Enoxaparin -DVT associated with or not PE 100 IU/kg/12 hours or 1mg/kg/12 hours - subcutaneous 3 to 4 hours after the injection 1.2 (+- 0.17) IU/mL Slightly prolonged
-Acute coronary syndrome
Dalteparin -Constituted DVT 100 to 120 IU/kg/12 hours – subcutaneous 0.6 (+- 0.25) IU/mL (overdose threshold 1.0 IU/mL)
Nadroparin -Unstable angina -Myocardial infarction without Q wave 85 IU/kg/12 hours 1.0 (+- 0.2) IU/mL
Low molecular weight heparins: 1 injection per day†
Tinzaparin -Constituted DVT 175 IU/kg/24h 4 to 6 hours after the injection 0.87 (+- 0.15) IU/mL (overdose threshold: <1.5 IU/mL) Prolonged
-PE
Nadroparin -Constituted DVT 171 IU/kg/24h   1.34 (+- 0.15) IU/mL (overdose threshold: <1.8 IU/mL) Slightly prolonged
Fondaparinux  
Fondaparinux -Constituted DVT In patients with DVT or PE, dosing was determined by patient weight, with either 5 mg (weight <50 kg), 7.5 mg (weight 50–100 kg), or 10 mg (weight >100 kg) administered/24hours. 2 to 3 hours after administration The mean peak steady state concentrations for were 1.20–1.26 mg/L Not prolonged
-PE
  -Acute coronary syndrome 2.5 mg/24 hours 2 to 3 hours after administration Healthy males receiving a single 2.5 mg dose of fondaparinux had an average peak steady state (3 hours) concentration of 0.39–0.5 mg/L
  1. †In neonates or children receiving therapeutic LMWH either once or twice daily the drug should be monitored to a target anti-Xa of 0.5–1.0 IU/mL in a sample taken 4–6 hours or 0.5–0.8 IU/mL in a sample taken 2–6 hours after subcutaneous injection [157].