title: Continuous intravenous infusion of a low-molecular-weight heparin during allogenic haematopoietic stem-cell transplantation.
abstract: Low-molecular-weight heparins are routinely administered once or twice daily by subcutaneous injection. With the exception of patients on haemodialysis or presenting with unstable angina or flat Q-wave myocardial infarction, in which short-term intravascular administration is recommended, little information is available regarding the efficacy of continuous intravenous administration of low-molecular-weight heparins. We report the case of a 50-year-old patient who underwent an allogenic haematopoietic stem-cell transplantation for acute myeloid leukaemia. Prior to transplantation, the patient was on long-term oral anticoagulant (acenocoumarol) following the placement of a mechanical aortic valve. Acenocoumarol was stopped and low-molecular-weight heparin (nadroparin calcium) was administered intravenously through a continuous infusion pump (30 000 anti-Xa U/day) starting from day 0 until day 23 after transplantation. The patient was prophylactically transfused with platelets when the daily platelet count fell below 50 x 10 l. Repeated blood measurements showed that a therapeutic level of anti-Xa activity was achieved and maintained at a fairly constant level. No haemorrhagic or thrombotic complications occurred. This observation suggests that intravenous continuous infusion of low-molecular-weight heparin may be an alternative to subcutaneous injections in selected patients who need anticoagulation.
authors.affiliation: Haemostasis Laboratory, Department of Biological Chemistry, Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Brussels, Belgium.
authors.forename: Anca
authors.initials: A
authors.lastname: Boeras
authors.forename: Catherine
authors.initials: C
authors.lastname: Lambert
authors.forename: Augustin
authors.initials: A
authors.lastname: Ferrant
authors.forename: Eric
authors.initials: E
authors.lastname: van den Neste
authors.forename: Cedric
authors.initials: C
authors.lastname: Hermans
mesh_terms: D000208:Acute Disease; D000925:Anticoagulants / Q000008:administration & dosage*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007262:Infusions, Intravenous; D007951:Leukemia, Myeloid / Q000628:therapy; D008875:Middle Aged; D017762:Nadroparin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D017762:Nadroparin