Parenteral Anticoagulants For The Treatment Of Antiphospholipid Antibody Syndrome

Parenteral anticoagulants for the treatment of Antiphospholipid Antibody Syndrome

• Unfractionated heparin.
- – Prophylactic dose: 5000 units SC twice a day.
- – Treatment of clot dose: 80 units/kg bolus followed by 18 units/kg/h IV maintenance.
- – Monitor PTT, antifactor Xa level (6 hours after dose adjustment), or heparin level.
- – Precautions: heparin-induced thrombocytopenia (HIT), osteoporosis.
• LMWHs.
- – Prophylactic dose.
  - Dalteparin (Fragmin): 5000 anti-Xa units SC q24 hours.
  - Enoxaparin (Lovenox): 30 mg SC q12 hours (or 40 mg SC q24 hours).
  - Tinzaparin (Innohep): 75 anti-Xa units/kg SC q24 hours.
- – Treatment of clot dose.
  - Dalteparin (Fragmin): 100 anti-Xa units/kg SC q12 hours (or 200 anti-Xa units/kg SC q24 hours).
  - Enoxaparin (Lovenox): 1 mg/kg SC q12 hours (or 1.5 mg/kg SC q24 hours).
  - Tinzaparin (Innohep): 175 anti-Xa units/kg SC q24 hours.
- – Caveats.
  - Use cautiously with dose adjustment if creatinine clearance (CrCl) <30 mL/minute since not dialyzable.
  - Monitor: antifactor Xa level 4 hours after dose.
  - Less risk of HIT and osteoporosis.
  - More expensive than unfractionated heparin.