title: Administration of dalteparin based on the activated clotting time for prophylaxis of hepatic vessel thrombosis in living donor liver transplantation.
abstract: Beginning in 2004, dalteparin doses based on activated clotting time (ACT) were administered for hepatic vessel thrombosis prophylaxis in living donor liver transplantation (LDLT). We verified the feasibility of this new therapy by comparing it with the previous one. From 1993 through 2008, 42 metabolic liver patients who underwent LDLT were divided into two groups. Group A (1993-2003, n = 32) was administered a fixed dalteparin dose and a large amount of fresh frozen plasma (FFP); Group B (2004-2008, n = 10) was administered an appropriate dosage of dalteparin to maintain the ACT levels from 140 to 150 seconds and a small amount of FFP. Group B was administered a lesser amount of FFP and more dalteparin. This resulted in longer activated partial thromboplastin time, lower fibrinogen degradation products D-dimer, and lower aspartate aminotransferase levels compared to group A; all differences were significant. Group B showed neither thrombotic nor hemorrhagic complications. Anticoagulation therapy comprising adjustment of the dalteparin dose based on ACT reduces thrombotic complications without increasing hemorrhagic complications. ACT measurement is a simple, reliable method for bedside monitoring of dalteparin anticoagulant effects for LDLT.
authors.affiliation: Department of Surgery, Shinshu University School of Medicine, Nagano, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Uchikawa
authors.forename: T
authors.initials: T
authors.lastname: Ikegami
authors.forename: Y
authors.initials: Y
authors.lastname: Masuda
authors.forename: Y
authors.initials: Y
authors.lastname: Ohno
authors.forename: A
authors.initials: A
authors.lastname: Mita
authors.forename: K
authors.initials: K
authors.lastname: Urata
authors.forename: Y
authors.initials: Y
authors.lastname: Nakazawa
authors.forename: M
authors.initials: M
authors.lastname: Terada
authors.forename: S
authors.initials: S
authors.lastname: Miyagawa
mesh_terms: D000328:Adult; D000990:Antithrombin III / Q000627:therapeutic use; D001777:Blood Coagulation / Q000187:drug effects; D016913:Blood Component Transfusion; D017985:Dalteparin / Q000627:therapeutic use*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008102:Liver Circulation / Q000187:drug effects / Q000502:physiology*; D016031:Liver Transplantation / Q000502:physiology*; D019520:Living Donors; D008297:Male; D010314:Partial Thromboplastin Time; D010949:Plasma; D013927:Thrombosis / Q000517:prevention & control*; D014914:Whole Blood Coagulation Time
chemical_list: D005343:Fibrinolytic Agents; D000990:Antithrombin III; D006493:Heparin; D017985:Dalteparin