Changes in the pharmacokinetics of the low-molecular-weight heparin enoxaparin sodium during pregnancy

Casele, Holly L.; Laifer, Steven A.; Woelkers, Douglas; Venkataramanan, Raman

doi:10.1016/s0002-9378(99)70091-8

Cited by 208 publications

(108 citation statements)

References 13 publications

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“…[19][20][21] These effects are mediated by the hemodynamic alterations of pregnancy mainly because of the increase in glomerular filtration rate, as enoxaparin is exclusively excreted by the kidney. 18,19 Our study shows sub-therapeutic anti-factor Xa activity during a substantial portion of the observation period, that is, 20% of the 8-h after dosing and 73% of the trough anti-factor Xa activity levels…”

Section: Discussionmentioning

confidence: 69%

“…Maternal physiological increases in plasma volume and glomerular filtration rate alter enoxaparin drug levels and may lead to lower anti-factor Xa activity. 18,19 The aim of this study was to evaluate pre-and post-dose antifactor Xa levels in pregnant patients requiring therapeutic enoxaparin at various gestational ages, and to estimate and discuss the adequacy of anticoagulation over the standard 12-h dosing interval.…”

Section: Introductionmentioning

confidence: 99%

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Fluctuations in anti-factor Xa levels with therapeutic enoxaparin anticoagulation in pregnancy

Friedrich¹,

Hameed²

2009

J Perinatol

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Objective: The objective of the study was to evaluate anti-factor Xa levels with therapeutic enoxaparin anticoagulation in pregnancy.Study Design: A total of 15 pregnant subjects on therapeutic doses of enoxaparin (1 mg/kg ±20% subcutaneously (s.c.) twice daily (b.i.d.)) were enrolled prospectively in this cross-sectional pilot project. Three blood levels for anti-factor Xa activity were examined: before the enoxaparin dose (trough), 3-to 4-h later (peak) and 8-h later. Anti-factor Xa activity level between 0.5 and 1.2 U/ml was considered therapeutic.Result: Mean anti-factor Xa activity levels were: trough 0.45±0.18, peak 0.9 ± 0.25 and 8-h after dose 0.72 ± 0.23 U/ml. All peak levels were therapeutic; 20% (3/15) of the 8 h and 73% (11/15) of the trough levels were sub-therapeutic.Conclusion: Trough and 8-h post-dose anti-factor Xa activity levels were sub-therapeutic in a substantial number of patients receiving a b.i.d. regimen of therapeutic enoxaparin.

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Section: Discussionmentioning

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Fluctuations in anti-factor Xa levels with therapeutic enoxaparin anticoagulation in pregnancy

Friedrich¹,

Hameed²

2009

J Perinatol

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“…In pregnancy, the volume of distribution and renal clearance increases, leading to a lower peak and shorter duration of anti-Xa activity, but with continued use the anti-Xa activity can become prolonged [121] Therapeutic doses after ART may be indicated during pregnancy in women who present with acute VTE, those at high risk of recurrent thromboembolism and women with major cardiac disease at risk of arterial embolism [122]. The therapeutic dose is 1 mg/ kg enoxaparin twice daily.…”

Section: Dose Regiment Of Lmwhmentioning

confidence: 99%

Thrombophilia in Assisted Reproductive Technology — Place and Needs of Thromboprophylaxis

Ivanov¹,

Tomov²,

Tsvyatkovska³

et al. 2013

Pregnancy Thrombophilia - The Unsuspected Risk

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“…Se administran de manera subcutánea. Alcanzan su nivel máximo a las 4 horas durante el embarazo (33,34), con una vida media de 4 a 5 horas (35). Se monitorizan mediante la cuantificación de niveles de antifactor Xa, no poseen traspaso placentario (26,36,37) y no se les asocian efectos adversos fetales (38).…”

Section: Tabla I Indicaciones De Distintos Niveles De Anticoagulaciónunclassified

Anticoagulación Y Embarazo

M³

et al. 2006

Rev. chil. obstet. ginecol.

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RESUMENSe comentan los aspectos clínicos del tratamiento anticoagulante en la paciente embarazada. PALABRAS CLAVES: Anticoagulantes, trombosis, trombofilia, embarazo SUMMARYThe clinical aspects of the anticoagulant treatment in pregnant patient are commented.KEY WORDS: Anticoagulants, thrombosis, thrombophilia, pregnancy Documentos INTRODUCCIÓNEl embarazo humano normal se asocia con alteraciones importantes en todos los componentes de la triada de Virchow, de tal forma que el efecto procoagulante se vuelve dominante (1). El embarazo es un estado de hipercoagulabilidad en el que se puede incrementar hasta en cinco veces el riesgo de eventos tromboembólicos (2). Los cambios en el sistema de coagulación comienzan en el momento de la concepción y sólo terminan 8 semanas postparto (3).En mujeres con trombofilia, el riesgo durante el embarazo se incrementa hasta el doble de un embarazo normal (4). También poseen riesgo aumentado de desprendimiento placentario, preeclampsia, restricción del crecimiento intrauterino, muerte fetal in útero y probablemente aborto (5).La terapia anticoagulante se indica durante el embarazo para la prevención y tratamiento del embolismo sistémico en pacientes portadoras de válvulas cardiacas mecánicas y valvulopatías con fibrilación auricular (6.) Habitualmente también, para la prevención de complicaciones durante el embarazo en mujeres con anticuerpos antifosfolípidos y otras trombofilias que han presentado complicaciones con anterioridad (7).El objetivo de esta comunicación es presentar los aspectos básicos del tratamiento anticoagulante durante el embarazo. Indicaciones de anticoagulaciónA pesar del aumento del riesgo de trombosis durante el embarazo y posparto, la mayoría de las mujeres no requieren anticoagulación. Aunque algunos expertos recomendarían tromboprofilaxis en todas las embarazadas con trombofilia hereditaria, la anticoagulación no es necesaria si no existe historia personal de tromboembolismo o una mala historia obstétrica (7). Las excepciones son las mujeres con deficiencia de antitrombina, mutación homocigota para el factor V de Leiden, mutación homocigota para el gen de protrombina G20210A o heterocigota para ambas mutaciones (heterocigota compuesta) (8). En la mayoría de

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Changes in the pharmacokinetics of the low-molecular-weight heparin enoxaparin sodium during pregnancy

Cited by 208 publications

References 13 publications

Fluctuations in anti-factor Xa levels with therapeutic enoxaparin anticoagulation in pregnancy

Fluctuations in anti-factor Xa levels with therapeutic enoxaparin anticoagulation in pregnancy

Thrombophilia in Assisted Reproductive Technology — Place and Needs of Thromboprophylaxis

Anticoagulación Y Embarazo

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