Enoxaparin sodium
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Haemorrhage: 6 cases Six patients developed a bleeding event during treatment with enoxaparin sodium [route not stated]. A 68-year-old woman, who had a mechanical valve and was receiving warfarin, started receiving enoxaparin sodium at an initial dosage of 0.87 mg/kg every 12 h. She subsequently experienced gastrointestinal bleeding on day 5 of therapy. Her haemoglobin fell by 2 g/dL and she received 2 units of packed red blood cells. Enoxaparin sodium was discontinued and she temporally received unfractionated heparin [patient outcome not stated]. A 44-year-old man, who had a BMI of 46.1 kg/m2, started receiving enoxaparin sodium at an initial dosage of 0.67 mg/kg every 12 h for venous thromboembolism. He subsequently experienced a spinal haematoma on day 2 of therapy. His haemoglobin fell by 2.5 g/dL and he received 2 units of packed red blood cells. Enoxaparin sodium was discontinued [patient outcome not stated]. A 21-year-old man, who had a BMI of 49.3 kg/m2, started receiving enoxaparin sodium at an initial dosage of 0.8 mg/kg every 12 h for venous thromboembolism. He subsequently experienced a gluteal haematoma on day 28 of therapy. His haemoglobin fell by 3 g/dL and he received 4 units of packed red blood cells. Enoxaparin sodium was discontinued and he received a IVC filter [patient outcome not stated]. A 78-year-old woman, who had a BMI of 40.2 kg/m2, started receiving enoxaparin sodium at an initial dosage of 0.83 mg/kg every 12 h for venous thromboembolism; her dosage was reduced to 0.67 mg/kg every 12 h on day 3. She subsequently experienced gastrointestinal bleeding on day 25 of therapy. Her haemoglobin fell by 2 g/dL and she received 3 units of packed red blood cells. Enoxaparin sodium was discontinued and she was discharged without further anticoagulation therapy. A 50-year-old woman, who had a BMI of 40.1 kg/m2, started receiving enoxaparin sodium at an initial dosage of 0.75 mg/kg every 12 h for venous thromboembolism. She subsequently experienced bleeding on day 18 of therapy. Her haemoglobin fell by >4 g/dL and she received 4 units of packed red blood cells. She did not recover; 1 day after enoxaparin discontinuation, she developed respiratory failure and care was withdrawn. A 74-year-old woman, who had a BMI of 60.2 kg/m2 and who was receiving warfarin, started receiving enoxaparin sodium at an initial dosage of 0.9 mg/kg every 12 h for atrial fibrillation. She subsequently experienced bleeding on day 7 of therapy. Her haemoglobin fell by 2 g/dL and she received 2 units of packed red blood cells. She subsequently died following withdrawal of care, 14 days after starting enoxaparin. Deal EN, et al. Evaluation of therapeutic anticoagulation with enoxaparin and associated anti-Xa monitoring in patients with morbid obesity: A case series. Journal of Thrombosis and Thrombolysis 32: 188-194, No. 2, Aug 2011. Available 803062761 from: URL: http://dx.doi.org/10.1007/s11239-011-0584-7 - USA
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