PMID- 21098749
OWN - NLM
STAT- MEDLINE
DCOM- 20110301
LR  - 20131121
IS  - 1542-6270 (Electronic)
IS  - 1060-0280 (Linking)
VI  - 44
IP  - 12
DP  - 2010 Dec
TI  - Subcutaneous unfractionated heparin for treatment of venous thromboembolism in 
      end-stage renal disease.
PG  - 2023-7
LID - 10.1345/aph.1P403 [doi]
AB  - OBJECTIVE: To report 3 cases of venous thromboembolism (VTE) in patients with 
      end-stage renal disease (ESRD) treated with subcutaneous unfractionated heparin 
      (UFH) bridged with warfarin. CASE SUMMARIES: Three patients with ESRD were 
      successfully treated for VTE with unmonitored, fixed-dose subcutaneous UFH every 
      12 hours and dose-adjusted warfarin. The first patient was initiated on 
      continuous infusion UFH for deep-vein thrombosis, but due to poor vascular 
      access, nurses were unable to consistently measure anti-Xa levels. Therefore, 
      subcutaneous UFH 17,500 units ( approximately 245 units/kg/dose) every 12 hours was initiated. 
      Oral warfarin 5 mg/day was started the following day. The patient received 4 days 
      of inpatient subcutaneous UFH and then was discharged to complete the bridge as 
      an outpatient. The second patient received subcutaneous UFH 10,000 units ( approximately 244 
      units/kg/dose) every 12 hours and oral warfarin 2.5 mg/day to treat a 
      nonocclusive thrombus along her right femoral vein hemodialysis catheter. The 
      patient received 1 day of inpatient subcutaneous UFH treatment prior to discharge 
      and continued bridge therapy with warfarin as an outpatient. The third patient 
      was initiated on subcutaneous UFH 20,000 units ( approximately 223 units/kg/dose) every 12 
      hours and oral warfarin 7.5 mg/day due to a subtherapeutic INR (1.50) 5 days 
      after receiving fresh frozen plasma to reduce her therapeutic INR for a 
      procedure. The patient received 2 doses of subcutaneous UFH as an inpatient 
      before treatment was discontinued because her INR was therapeutic at 2.3. 
      DISCUSSION: Subcutaneous UFH has been used to treat VTE since the early 1980s; 
      however, with the advent of low-molecular-weight heparin (LMWH), subcutaneous UFH 
      use diminished. Several studies comparing the use of subcutaneous UFH to both 
      continuous infusion UFH and LMWH concluded that subcutaneous UFH is a safe and 
      efficacious alternative. The 2008 Chest Guidelines for Antithrombotic Therapy for 
      Venous Thromboembolic Disease support the use of subcutaneous UFH for the 
      treatment of VTE with a Grade 1A recommendation and provide a Grade 2C 
      recommendation for use of UFH over LMWH for patients with VTE and severe renal 
      failure. CONCLUSIONS: Safe and convenient treatment options for VTE in patients 
      with ESRD are limited. Fixed-dose, unmonitored subcutaneous UFH as a bridge to 
      warfarin therapy is an effective option in patients with ESRD and those with 
      financial restrictions. The pharmacist plays a key role in identifying patients 
      for whom subcutaneous UFH treatment may be a viable alternative, recommending an 
      appropriate dosing regimen, and educating health-care professionals and patients 
      about safe use.
FAU - Metzger, Nicole L
AU  - Metzger NL
AD  - College of Pharmacy and Health Sciences, Mercer University, Atlanta Campus, 
      Atlanta, GA, USA. Metzger_NL@mercer.edu
FAU - Chesson, Melissa M
AU  - Chesson MM
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20101123
PL  - United States
TA  - Ann Pharmacother
JT  - The Annals of pharmacotherapy
JID - 9203131
RN  - 0 (Anticoagulants)
RN  - 5Q7ZVV76EI (Warfarin)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Anticoagulants/administration & dosage/therapeutic use
MH  - Drug Therapy, Combination
MH  - Female
MH  - Heparin/administration & dosage/*therapeutic use
MH  - Humans
MH  - Infusions, Subcutaneous
MH  - Kidney Failure, Chronic/complications/*drug therapy
MH  - Venous Thromboembolism/complications/*drug therapy
MH  - Warfarin/therapeutic use
EDAT- 2010/11/26 06:00
MHDA- 2011/03/02 06:00
CRDT- 2010/11/25 06:00
PHST- 2010/11/25 06:00 [entrez]
PHST- 2010/11/26 06:00 [pubmed]
PHST- 2011/03/02 06:00 [medline]
AID - aph.1P403 [pii]
AID - 10.1345/aph.1P403 [doi]
PST - ppublish
SO  - Ann Pharmacother. 2010 Dec;44(12):2023-7. doi: 10.1345/aph.1P403. Epub 2010 Nov 
      23.