title: Heparin monitoring: clinical outcome and practical approach.
abstract: Traditional anticoagulant agents such as unfractionated heparin (UFH), low molecular weight heparins (LMWHs), fondaparinux, danaparoid and bivalirudine are used in the prevention and treatment of thromboembolic diseases. However, these agents have limitations: their constraining parenteral route of administration and the need for regular coagulation monitoring for HNF. The LMWHs, with their more predictable anticoagulant response, don't require a systematic monitoring. The usefulness of LMWHs monitoring in several clinical situations such as pregnancy, obesity and renal insufficiency is a matter of debate. Indeed, there is no agreement between French and American recommendations on this question. Others aspects are also controversial: the measure of trough anti-Xa activity during pregnancy and the optimal monitoring of LMWHs for patients with antithrombin deficiency (hepatic disease, new-borns). Different tests are available to ensure the monitoring of these drugs, we will see in this review their principle, their advantages and inconvenients. The management of heparin induced thrombocytopenia also needs parenteral anticoagulants: danaparoïd, bivalirudine or argatroban. The modalities of their monitoring are relatively unknown and are presented. Furthermore, platelet monitoring is capital. This article aims to provide guidance about laboratory testing of classic parenteral anticoagulants.
authors.affiliation: Université catholique de Louvain, CHU UCL Namur, Namur thrombosis and hemostasis center, Hematology-hemostasis laboratory, Yvoir, Belgique.
authors.forename: Noémie
authors.initials: N
authors.lastname: Despas
authors.affiliation: Université catholique de Louvain, CHU UCL Namur, Namur thrombosis and hemostasis center, Department of pharmacy, Yvoir, Belgique.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Larock
authors.affiliation: Université catholique de Louvain, CHU UCL Namur, Namur thrombosis and hemostasis center, Hematology-hemostasis laboratory, Yvoir, Belgique.
authors.forename: Hugues
authors.initials: H
authors.lastname: Jacqmin
authors.affiliation: Department of pharmacy, Namur thrombosis and hemostasis center (NTHC), Namur research institute for life sciences (NARILIS), Université de Namur, Namur, Belgique.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Douxfils
authors.affiliation: Université catholique de Louvain, CHU UCL Namur, Namur thrombosis and hemostasis center, Hematology-hemostasis laboratory, Yvoir, Belgique.
authors.forename: Bernard
authors.initials: B
authors.lastname: Chatelain
authors.affiliation: Université catholique de Louvain, CHU UCL Namur, Namur thrombosis and hemostasis center, Hematology-hemostasis laboratory, Yvoir, Belgique.
authors.forename: Marc
authors.initials: M
authors.lastname: Chatelain
authors.affiliation: Université catholique de Louvain, CHU UCL Namur, Namur thrombosis and hemostasis center, Hematology-hemostasis laboratory, Yvoir, Belgique.
authors.forename: François
authors.initials: F
authors.lastname: Mullier
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011247:Pregnancy; D013923:Thromboembolism / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D006493:Heparin
keywords: fondaparinux; low molecular weight heparins; monitorin; unfractionated heparin