PMID- 15927907
OWN - NLM
STAT- MEDLINE
DCOM- 20050927
LR  - 20190917
IS  - 0277-0008 (Print)
IS  - 0277-0008 (Linking)
VI  - 25
IP  - 6
DP  - 2005 Jun
TI  - Life-threatening hemorrhage after dalteparin therapy in a patient with impaired 
      renal function.
PG  - 881-5
AB  - Dalteparin and other low-molecular-weight heparins are frequently used for the 
      treatment of deep vein thrombosis and for other indications. Unlike 
      unfractionated heparin (UFH), dalteparin is mainly cleared through the kidney; 
      therefore, it can accumulate in patients with impaired renal function, increasing 
      the risk of hemorrhage. An 84-year-old woman with chronic renal failure was 
      hospitalized because of stenosis of a femorofibular bypass in her right leg. 
      Peripheral transluminal angioplasty was performed successfully. Later the same 
      day, Doppler sonography revealed deep vein thrombosis of the left lower leg. 
      Treatment with dalteparin was started. The patient was discharged home 3 days 
      later, with dalteparin to be continued at home. One day later, the patient was 
      rehospitalized because of a pronounced hematoma on her flank. Her hemoglobin 
      level had dropped to 5.5 g/dl. Treatment with dalteparin was stopped, and 
      protamine 2500 U and two transfusions of packed red blood cells were 
      administered. Treatment with UFH and oral anticoagulants were started because of 
      a persistent risk for venous thrombosis. Thereafter, the patient's hemoglobin 
      level remained stable, and no further bleeding episodes occurred. As long as 
      systematic studies of the efficacy and safety of dalteparin in patients with 
      severe renal impairment are lacking, dalteparin should be avoided or used only 
      with close monitoring of antifactor Xa activity in these patients. As an 
      alternative, UFH can be used because monitoring of UFH is well established and 
      easier than it is with dalteparin. Renal impairment does not notably influence 
      the short elimination half-life of UFH, which unlike that of dalteparin or other 
      low-molecular-weight heparins allows for rapid dosage adjustments to prevent 
      hemorrhage.
FAU - Egger, Sabin S
AU  - Egger SS
AD  - Clinic of Pharmacology and Toxicology, Department of Internal Medicine, 
      University Hospital, Basel, Switzerland. eggers@uhbs.ch
FAU - Sawatzki, Mikael G
AU  - Sawatzki MG
FAU - Drewe, Jurgen
AU  - Drewe J
FAU - Krahenbuhl, Stephan
AU  - Krahenbuhl S
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Pharmacotherapy
JT  - Pharmacotherapy
JID - 8111305
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin Antagonists)
RN  - 0 (Protamines)
RN  - S79O08V79F (Dalteparin)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*adverse effects/pharmacokinetics
MH  - Dalteparin/*adverse effects/pharmacokinetics
MH  - Female
MH  - Hematoma/*chemically induced/drug therapy
MH  - Heparin Antagonists/therapeutic use
MH  - Humans
MH  - Kidney Failure, Chronic/metabolism
MH  - Metabolic Clearance Rate
MH  - Protamines/therapeutic use
MH  - Venous Thrombosis/*drug therapy
EDAT- 2005/06/02 09:00
MHDA- 2005/09/28 09:00
CRDT- 2005/06/02 09:00
PHST- 2005/06/02 09:00 [pubmed]
PHST- 2005/09/28 09:00 [medline]
PHST- 2005/06/02 09:00 [entrez]
AID - 10.1592/phco.2005.25.6.881 [doi]
PST - ppublish
SO  - Pharmacotherapy. 2005 Jun;25(6):881-5. doi: 10.1592/phco.2005.25.6.881.