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Post-Transplant Events

Safety of low-dose low-molecular-weight-heparins in thrombocytopenic stem cell transplantation patients: a case series and review of the literature

Bone Marrow Transplantation volume 35, pages 1071–1077 (2005)Cite this article

Summary:

Few attempts have been made to examine the feasibility of safely administering low-molecular-weight-heparins (LMWHs) in the presence of concurrent thrombocytopenia. We retrospectively investigated the safety of low-dose LMWH in BMT patients, a population at risk of bleeding. In total, 26 patients received at least one dose of low-dose enoxaparin (ie <1 mg/kg/day) during thrombocytopenia. s.c. enoxaparin 40 mg once daily was given in 85% of the cohort. The mean number of platelet days <55 × 109 and <20 × 109/l were 16.5 days (95% CI=8.04–24.96) and 4.14 days (95% CI=2.35–5.93), respectively. The mean number of low-dose enoxaparin administration days when platelet <55 × 109 and 20 × 109/l were 9.89 days (95% CI=3.26–16.53) and 2.25 days (95% CI=0.57–3.93), respectively. Minor bleeding occurred in four patients (15%) whereas major episodes developed in two patients (8%). The latter two events occurred during the transition between full therapeutic (ie 1.5–2 mg/kg/day) and low-dose enoxaparin close to the onset of thrombocytopenia. The present case series, along with the discussed literature, descriptively suggests that low-dose enoxaparin may be safely administered at a platelet count in the range of 20 and 55 × 109/l in BMT patients who weigh >55 kg.

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Acknowledgements

Natalie A Dieterle, PA-C and Jennifer Kozlowski, NP for their valuable editorial review of the manuscript. The study was partially supported by an NCI Cancer Center Support Grant, CA-22453.

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Authors and Affiliations

  1. Department of Pharmacy, Karmanos Cancer Institute/Harper University Hospital/The Detroit Medical Center, Detroit, MI, USA

    R B Ibrahim, M M Gumma & N Milan

  2. Eugene Applebaum College of Pharmacy and Allied Health Professions, Wayne State University, 3990 John R, Detroit, MI, USA

    R B Ibrahim

  3. Bone Marrow Transplantation Service, Karmanos Cancer Institute, School of Medicine, Wayne State University, Detroit, MI, USA

    E Peres, R Dansey, M H Abidi, E M Abella & J Klein

  4. Biostatistics Core, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA

    D W Smith & L K Heilbrun

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  1. R B Ibrahim
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Correspondence to R B Ibrahim.

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Ibrahim, R., Peres, E., Dansey, R. et al. Safety of low-dose low-molecular-weight-heparins in thrombocytopenic stem cell transplantation patients: a case series and review of the literature. Bone Marrow Transplant 35, 1071–1077 (2005). https://doi.org/10.1038/sj.bmt.1704952

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