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The activated clotting time can be used to monitor the low molecular weight heparin dalteparin after intravenous administration

Jonathan D. Marmur, MD, FACC^*,*, Sunil X. Anand, BA, Ramanjit S. Bagga, MD, Jawed Fareed, PhD, Chi-Miau Pan, PhD, Samin K. Sharma, MD, FACC and Merwin F. Richard, MD

^* Department of Medicine, Division of Cardiology, SUNY Health Science Center at Brooklyn, Brooklyn, New York, USA
Zena and Michael A. Weiner Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York, USA
Hemostasis and Thrombosis Research Laboratories, Loyola University Medical Center, Maywood, Illinois, USA
Research Division, International Technidyne Corporation, Edison, New Jersey, USA

View larger version (20K): [in a new window]   Figure 1 Patient flow for the in vitro dose response (volunteers), in vivo dose response, and monitoring studies. Abx = administration of abciximab; IV = intravenous; SC = subcutaneous.

View larger version (14K): [in a new window]   Figure 2 In vitro dose-response of the activated clotting time (ACT) as a function of increasing concentration of anticoagulant in whole blood. Samples were derived from healthy volunteers (n = 10) and aliquots (n = 200) were treated with increasing doses of either unfractionated heparin (UFH) (circles) or dalteparin (squares). Data presented as mean ± SD.

View larger version (19K): [in a new window]   Figure 3 In vivo dose-response of the ACT as a function of the cumulative doses of UFH (circles) or dalteparin (squares). Patients (n = 15) initially received dalteparin (40 + 40 IU/kg 5 min apart, for a total of 80 IU/kg), and then, following a 12-h delay to allow elimination of dalteparin and return of the ACT to baseline, received UFH (40 + 30 U/kg 5 min apart, for a total of 70 U/kg). Data presented as mean ± SD. Abbreviations as in Figure 2.

View larger version (45K): [in a new window]   Figure 4 Indices of coagulation following administration of intravenous (IV) dalteparin 60 IU/kg (n = 18) and IV dalteparin 80 IU/kg (n = 26). Data presented as mean (95% confidence interval). * p < 0.001 for all time points compared to baseline. Black bars = dalteparin 60 IU/kg; gray bars = dalteparin 80 IU/kg.