PMID- 31766856
OWN - NLM
STAT- MEDLINE
DCOM- 20200907
LR  - 20200907
IS  - 1542-6270 (Electronic)
IS  - 1060-0280 (Linking)
VI  - 54
IP  - 5
DP  - 2020 May
TI  - Cirrhosis, Thrombosis, Finding FaXts about Doses: Dosing of Unfractionated 
      Heparin for Venous Thromboembolism in Cirrhosis.
PG  - 450-456
LID - 10.1177/1060028019890028 [doi]
AB  - Background: Despite known disease-specific alterations to anti-factor Xa (AXA) 
      levels, the physiological response of patients with cirrhosis to unfractionated 
      heparin (UFH) infusions is not well established in clinical settings. Objective: 
      The purpose of this study was to characterize the dosing and safety profile of 
      UFH in patients with varying degrees of cirrhosis when treated for venous 
      thromboembolism (VTE). Methods: This retrospective observational study was 
      conducted at a single academic medical center in the United States. Patients with 
      a diagnosis of cirrhosis who received UFH infusions for greater than 48 hours for 
      treatment of VTE were included. Comparisons between heparin infusion rates, AXA 
      levels, and safety outcomes based on severity of cirrhosis were made to define 
      differences between those groups. Results: When compared by compensation status 
      or by Child-Turcotte-Pugh (CTP) class, patients with more severe disease trended 
      toward lower initial AXA levels on heparin initiation and higher heparin 
      requirements to achieve therapeutic levels and were significantly less likely to 
      achieve therapeutic levels than patients with less severe disease (P = 0.001 for 
      compensation, P = 0.017 for CTP). Additionally, bleeding rates were higher in 
      patients with more severe disease, without reaching statistical significance. 
      Conclusion and Relevance: Patients with severe cirrhosis required higher doses of 
      heparin to achieve the same therapeutic AXA levels, but also tended to have 
      higher rates of bleeding compared with less severe cirrhosis. These results 
      represent further evidence of changes in heparin response as cirrhosis severity 
      increases and may suggest that current monitoring methods are suboptimal in this 
      patient population.
FAU - Franz, Nicholas D
AU  - Franz ND
AUID- ORCID: 0000-0002-7912-4334
AD  - University of Michigan Health System Department of Pharmacy Services, Ann Arbor, 
      MI, USA.
FAU - Brancaccio, Adamo
AU  - Brancaccio A
AD  - University of Michigan Health System Department of Pharmacy Services, Ann Arbor, 
      MI, USA.
FAU - Robinson, Adam C
AU  - Robinson AC
AD  - University of Michigan Health System Department of Pharmacy Services, Ann Arbor, 
      MI, USA.
FAU - Regal, Randolph E
AU  - Regal RE
AD  - University of Michigan Health System Department of Pharmacy Services, Ann Arbor, 
      MI, USA.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20191125
PL  - United States
TA  - Ann Pharmacother
JT  - The Annals of pharmacotherapy
JID - 9203131
RN  - 0 (Factor Xa Inhibitors)
RN  - 9005-49-6 (Heparin)
RN  - EC 3.4.21.6 (Factor Xa)
SB  - IM
MH  - Dose-Response Relationship, Drug
MH  - Drug Monitoring/methods
MH  - Factor Xa/analysis
MH  - Factor Xa Inhibitors/*administration & dosage/adverse effects/therapeutic use
MH  - Female
MH  - Hemorrhage/chemically induced
MH  - Heparin/*administration & dosage/adverse effects/therapeutic use
MH  - Humans
MH  - Infusions, Intravenous
MH  - Liver Cirrhosis/blood/complications/*drug therapy
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Severity of Illness Index
MH  - Time Factors
MH  - Venous Thromboembolism/blood/complications/*drug therapy
OTO - NOTNLM
OT  - anticoagulation
OT  - cirrhosis
OT  - heparin
OT  - thromboembolism
EDAT- 2019/11/27 06:00
MHDA- 2020/09/08 06:00
CRDT- 2019/11/27 06:00
PHST- 2019/11/27 06:00 [pubmed]
PHST- 2020/09/08 06:00 [medline]
PHST- 2019/11/27 06:00 [entrez]
AID - 10.1177/1060028019890028 [doi]
PST - ppublish
SO  - Ann Pharmacother. 2020 May;54(5):450-456. doi: 10.1177/1060028019890028. Epub 
      2019 Nov 25.