Safety of low-dose low-molecular-weight-heparins in thrombocytopenic stem cell transplantation patients: a case series and review of the literature.
Few attempts have been made to examine the feasibility of safely administering low-molecular-weight-heparins (LMWHs) in the presence of concurrent thrombocytopenia. We retrospectively investigated the safety of low-dose LMWH in BMT patients, a population at risk of bleeding. In total, 26 patients received at least one dose of low-dose enoxaparin (ie <1 mg/kg/day) during thrombocytopenia. s.c. enoxaparin 40 mg once daily was given in 85% of the cohort. The mean number of platelet days <55 x 10(9) and <20 x 10(9)/l were 16.5 days (95% CI=8.04-24.96) and 4.14 days (95% CI=2.35-5.93), respectively. The mean number of low-dose enoxaparin administration days when platelet <55 x 10(9) and 20 x 10(9)/l were 9.89 days (95% CI=3.26-16.53) and 2.25 days (95% CI=0.57-3.93), respectively. Minor bleeding occurred in four patients (15%) whereas major episodes developed in two patients (8%). The latter two events occurred during the transition between full therapeutic (ie 1.5-2 mg/kg/day) and low-dose enoxaparin close to the onset of thrombocytopenia. The present case series, along with the discussed literature, descriptively suggests that low-dose enoxaparin may be safely administered at a platelet count in the range of 20 and 55 x 10(9)/l in BMT patients who weigh >55 kg.
Ibrahim
R B
RB
Department of Pharmacy, Karmanos Cancer Institute/Harper University Hospital/The Detroit Medical Center, 3990 John R., Detroit, MI 48201-2020, USA. ribrahim@dmc.org
Peres
E
E
Dansey
R
R
Abidi
M H
MH
Abella
E M
EM
Gumma
M M
MM
Milan
N
N
Smith
D W
DW
Heilbrun
L K
LK
Klein
J
J
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001792:Blood Platelets / Q000166:cytology; D016026:Bone Marrow Transplantation / Q000379:methods; D015331:Cohort Studies; D017984:Enoxaparin / Q000494:pharmacology; D005260:Female; D006470:Hemorrhage / Q000517:prevention & control; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy; D010976:Platelet Count; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000379:methods*; D013921:Thrombocytopenia / Q000628:therapy*; D013997:Time Factors
D000925:Anticoagulants; D017984:Enoxaparin; D006495:Heparin, Low-Molecular-Weight