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Danaparoid use for haemodialysis in a morbidly obese patient with heparin-induced thrombocytopenia - Need for a higher than recommended weight-based dosing.
Thromb Res 2019; 180:70-73TR

Abstract

WHAT IS KNOWN AND OBJECTIVE

Heparin is widely used to prevent clotting of the extracorporeal circuit during haemodialysis (HD). Heparin-induced thrombocytopenia (HIT) is a potentially devastating immune mediated adverse drug reaction caused by the emergence of antibodies that activate platelets in the presence of heparin, leading to a pro-thrombotic state. Danaparoid is an alternative anticoagulant used in patients on HD with HIT but its dosing recommendations in obese patients on HD are relatively scarce.

CASE SUMMARY

We report a case of a 48-year-old morbidly obese patient who received weight-based dosing of danaparoid for HD with monitoring of anti-Xa activity. However, despite the patient's anti-Xa level being within the therapeutic range at various time points, the circuit lines kept clotting during HD.

WHAT IS NEW AND CONCLUSION

The report provides evidence that the manufacturer's recommendations on dosing danaparoid based on body weight may lead to sub-optimal therapeutic benefit and highlight the need for higher than recommended weight-based dosing in obese individuals on dialysis.

Authors+Show Affiliations

Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia; Blacktown Hospital, Western Sydney Local Health District (WSLHD), NSW 2148, Australia. Electronic address: ronald.castelino@sydney.edu.au.Blacktown Hospital, Western Sydney Local Health District (WSLHD), NSW 2148, Australia.Blacktown Hospital, Western Sydney Local Health District (WSLHD), NSW 2148, Australia; Western Sydney University Medical School, Australia.Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia; Blacktown Hospital, Western Sydney Local Health District (WSLHD), NSW 2148, Australia; Nepean Blue Mountains Local Health District, Australia.Blacktown Hospital, Western Sydney Local Health District (WSLHD), NSW 2148, Australia; Western Sydney University Medical School, Australia.

Pub Type(s)

Case Reports
Letter

Language

eng

PubMed ID

31229923

Citation

Castelino, Ronald L., et al. "Danaparoid Use for Haemodialysis in a Morbidly Obese Patient With Heparin-induced Thrombocytopenia - Need for a Higher Than Recommended Weight-based Dosing." Thrombosis Research, vol. 180, 2019, pp. 70-73.
Castelino RL, Maddula M, Tarafdar S, et al. Danaparoid use for haemodialysis in a morbidly obese patient with heparin-induced thrombocytopenia - Need for a higher than recommended weight-based dosing. Thromb Res. 2019;180:70-73.
Castelino, R. L., Maddula, M., Tarafdar, S., Sud, K., & Kairaitis, L. (2019). Danaparoid use for haemodialysis in a morbidly obese patient with heparin-induced thrombocytopenia - Need for a higher than recommended weight-based dosing. Thrombosis Research, 180, pp. 70-73. doi:10.1016/j.thromres.2019.06.008.
Castelino RL, et al. Danaparoid Use for Haemodialysis in a Morbidly Obese Patient With Heparin-induced Thrombocytopenia - Need for a Higher Than Recommended Weight-based Dosing. Thromb Res. 2019;180:70-73. PubMed PMID: 31229923.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Danaparoid use for haemodialysis in a morbidly obese patient with heparin-induced thrombocytopenia - Need for a higher than recommended weight-based dosing. AU - Castelino,Ronald L, AU - Maddula,Meghana, AU - Tarafdar,Surjit, AU - Sud,Kamal, AU - Kairaitis,Lukas, Y1 - 2019/06/15/ PY - 2019/04/30/received PY - 2019/06/08/revised PY - 2019/06/14/accepted PY - 2019/6/24/pubmed PY - 2020/1/10/medline PY - 2019/6/24/entrez KW - Danaparoid KW - Haemodialysis KW - Heparin-induced thrombocytopenia KW - Obesity SP - 70 EP - 73 JF - Thrombosis research JO - Thromb. Res. VL - 180 N2 - WHAT IS KNOWN AND OBJECTIVE: Heparin is widely used to prevent clotting of the extracorporeal circuit during haemodialysis (HD). Heparin-induced thrombocytopenia (HIT) is a potentially devastating immune mediated adverse drug reaction caused by the emergence of antibodies that activate platelets in the presence of heparin, leading to a pro-thrombotic state. Danaparoid is an alternative anticoagulant used in patients on HD with HIT but its dosing recommendations in obese patients on HD are relatively scarce. CASE SUMMARY: We report a case of a 48-year-old morbidly obese patient who received weight-based dosing of danaparoid for HD with monitoring of anti-Xa activity. However, despite the patient's anti-Xa level being within the therapeutic range at various time points, the circuit lines kept clotting during HD. WHAT IS NEW AND CONCLUSION: The report provides evidence that the manufacturer's recommendations on dosing danaparoid based on body weight may lead to sub-optimal therapeutic benefit and highlight the need for higher than recommended weight-based dosing in obese individuals on dialysis. SN - 1879-2472 UR - https://www.unboundmedicine.com/medline/citation/31229923/Danaparoid_use_for_haemodialysis_in_a_morbidly_obese_patient_with_heparin-induced_thrombocytopenia_-_Need_for_a_higher_than_recommended_weight-based_dosing L2 - https://linkinghub.elsevier.com/retrieve/pii/S0049-3848(19)30274-9 DB - PRIME DP - Unbound Medicine ER -