Achievement of Therapeutic Anti-Xa Levels in a Proven Heparin-Resistant Patient Through the Use of Nontraditional High-Dose Enoxaparin

Krajewski, Kristin C.; Smith, Kelly; Conwall, Katherine; Krajewski, Michael P.

doi:10.1177/1060028014554649

Cited by 5 publications

(2 citation statements)

References 24 publications

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“…Literatürde bu hastalara tekrarlanan lomber ponksiyonlar yapılması ve hatta gerekli olan olgulara şant takılması önerilmektedir (23). Tromboz olgularında UFH'e (unfraksiyone heparin) direnç olabileceği gibi aynı olgularda DMAH'e de direnç gelişebileceği bildirilmiştir (24). Bizim olgumuzda tedaviye TDP eklenmesi ile hastanın kliniğinde düzelme gözlenmiştir.…”

Section: Discussionunclassified

A Case Report: Cerebral Venosus Thrombosis with Status Epilepticus

Karalök¹,

TAŞKIN²,

BEKTAŞ³

et al. 2015

Turkish J Pediatr Dis

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Erken tanı ve tedavi, mortalite ve morbidite açısından önemlidir. Tanı için bilgisayarlı tomografi (BT), manyetik rezonans (MR), MR venografi, konvansiyonel anjiyografi, doppler ultrasonografi (yenidoğanlarda) kullanılan görüntüleme yöntemleridir (7). Artan kesitsel görüntüleme yöntemleriyle tanı konabilme sıklığı artmaktadır (8).Tedavisi semptomatik olup; enfeksiyon kontrolü, antiepileptik, antiödem ve antikoagülan tedavilerden oluşmaktadır (9). OLGu SuNuMuÖncesinde bilinen bir hastalığı olmayan 5 yaşında erkek hasta havale geçirme nedeniyle acil servise başvurdu. Başvurusundan 6 gün önce burun akıntısı, ateşi olmuş ve üst solunum yolu GİRİŞ Sinüs ven trombozu nadir görülen bir nörolojik hastalık olup sıklığı yaklaşık 0.4-0.7/100.000'dir (1). Semptomları; huzursuzluk, baş ağrısı ve kusma gibi intrakranial basınç artışı bulguları, nöbet, ensefalopati, kranial sinir paralizileri, papil ödem, motor defisit ve komadır (1). Trombüsün akut ve kronik durumuna göre bulgular değişmektedir. Pediatrik yaş grubunda en sık başvuru bulgusu nöbet olup, nöbet ve koma ile başvuru kötü prognostik kriterlerdir (2-5).Sinüs ven trombozunun en sık nedenlerini; santral sinir sistemi ve baş-boyun enfeksiyonları, dehidratasyon, kronik sistem hastalıkları (SLE, kronik böbrek yetmezliği), maligniteler, oral kontraseptifler, demir eksikliği, gestasyonel nedenler, asfiksi ve protrombotik bozukluklar oluşturmaktadır (6). ÖzETSinüs ven trombozu, çocukluk yaş grubunda nadir görülen ve hayatı tehdit eden bir durumdur. Başvurudaki klinik bulguları genellikle nonspesifiktir ve buna bağlı olarak da tanısı gecikir veya yanlış tanı alabilir. Morbidite ve mortaliteyi azaltmada erken tanı ve tedavi önemlidir. Nöbet kötü prognoz kriterlerinden biridir. Burada acil servise status epileptikusla başvuran 5 yaşında erkek bir olgu sunuldu. Başvurusundan 6 saat sonra sinüs ven trombozu tanısı konularak, tedavisi başlanan hasta şu an 6. ayında sekelsiz olarak izlenmektedir.

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Section: Discussionunclassified

A Case Report: Cerebral Venosus Thrombosis with Status Epilepticus

Karalök¹,

TAŞKIN²,

BEKTAŞ³

et al. 2015

Turkish J Pediatr Dis

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“…Since the modes of action are similar with concern to all three parenteral anticoagulants, resistance to one of these agents (eg, in the case of low AT III levels) should translate into resistance to all the other agents in this group. Only one case report has described the successful surmounting of heparin resistance via the application of unusually high doses of enoxaparin (1.5 mg/kg twice daily) 8 . To the best of our knowledge, no report has yet been published on the successful attainment of therapeutic anticoagulation using fondaparinux following complete unresponsiveness to LMWH.…”

Section: What Is Known and Objectivementioning

confidence: 99%

Effective use of fondaparinux in patient with unresponsiveness to nadroparin

et al. 2020

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What is known and objective Fondaparinux exhibits a similar mechanism of action as LMWH. Since both of these drugs bind to antithrombin and increase its affinity to factor Xa, fondaparinux is not expected to be an effective alternative anticoagulant to LMWH in case of LMWH resistance. Case summary We report on a case of effective anticoagulation using fondaparinux following total unresponsiveness to high doses of nadroparin administered twice daily, as confirmed via repeated anti‐Xa measurements. The antithrombin levels were within the normal range. What is new and conclusion To the best of our knowledge, this is the first report of the effective use of fondaparinux in the case of unresponsiveness to LMWH.

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Enoxaparin dosing in Noonan syndrome: a case report

Tran

Tey

2020

Pharmacy Practice and Res

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BackgroundNoonan syndrome is a genetic condition that typically includes heart abnormalities and characteristic facial features. Various bleeding disorders have been associated with Noonan syndrome. Some affected individuals have excessive bruising, nosebleeds or prolonged bleeding following injury or surgery. This paper describes anti‐Factor Xa levels following excessive enoxaparin dosing in a male patient with Noonan syndrome.Clinical detailsA 24‐year‐old male (weighing 53 kg) presented under Orthopaedics for his elective three‐stage scoliosis surgery for kyphoscoliosis. The patient was usually on warfarin for a mechanical valve replacement. Bridging enoxaparin was prescribed (initially 1.5 mg/kg, SC, daily), but failure to reach therapeutic anti‐Factor Xa levels (highest level 0.44 units/mL) resulted in escalating enoxaparin doses (90 mg, SC, twice daily).OutcomesDespite a doses of up to 1.7 mg/kg enoxaparin twice daily, the patient did not reach therapeutic anti‐Factor Xa levels according to recommended reference ranges. The patient’s regular warfarin dose was restarted and the enoxaparin was ceased once his International Normalised Ratio was within the therapeutic range. The patient was transferred to a a rehabilitation facility 10 days after surgery.ConclusionMedication assay ranges may not always be an accurate point of reference, particularly when patients present with unusual comorbidities. As health care moves towards patient‐centred care, it is essential that individual patient parameters are considered when monitoring medication treatment plans.

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Achievement of Therapeutic Anti-Xa Levels in a Proven Heparin-Resistant Patient Through the Use of Nontraditional High-Dose Enoxaparin

Abstract: High-dose enoxaparin may be an option to treat cancer patients with confirmed heparin resistance and venous thromboembolism.

Cited by 5 publications

References 24 publications

A Case Report: Cerebral Venosus Thrombosis with Status Epilepticus

A Case Report: Cerebral Venosus Thrombosis with Status Epilepticus

Effective use of fondaparinux in patient with unresponsiveness to nadroparin

Enoxaparin dosing in Noonan syndrome: a case report

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