Use of Low‐Molecular‐Weight Heparin to Bridge Therapy in Obese Patients and in Patients with Renal Dysfunction
Bibliographic record
Abstract
OBJECTIVE: To recommend strategies to bridge therapy with low-molecular-weight heparin (LMWH) in obese patients and in patients with renal dysfunction. METHODS: A MEDLINE search was performed of the literature from January 1966-November 2005. Published material dealing with bridging of anticoagulation therapy or short-term use of LMWH therapy in patients with renal dysfunction or obesity was reviewed. The manufacturers of enoxaparin, dalteparin, and tinzaparin were contacted for the references used to determine dosing recommendations. RESULTS: Although LMWH has been commonly used to bridge therapy, our search revealed no trials that specifically examined LMWH bridge therapy in obese patients or in patients with renal dysfunction. However, nine trials using LMWH in obese patients and 14 trials using LMWH in patients with renal dysfunction were identified. When compared with normal-weight individuals, obese patients receiving enoxaparin and dalteparin based on total body weight did not demonstrate higher hemorrhage rates or antifactor Xa levels. Subtherapeutic antifactor Xa levels were more common with once-daily dosing of enoxaparin than with dosing every 12 hours. Enoxaparin accumulates in patients with a creatinine clearance of 30 ml/minute or less; in this population, enoxaparin dosage adjustments have been attempted. Tinzaparin does not accumulate in patients with a creatinine clearance of 20 ml/minute or greater after at least 10 days of dosing. CONCLUSION: Obese patients, weighing 90-150 kg, receiving LMWH for bridge therapy should receive dosages based on total body weight. Unfractionated heparin is recommended in patients weighing more than 150 kg; however, if LMWH is used, antifactor Xa levels should be monitored. Bridging with enoxaparin should be limited to patients with a creatinine clearance greater than 30 ml/minute. The use of enoxaparin 1 mg/kg once/day for patients with a creatinine clearance of 30 ml/minute or less is not recommended for anticoagulation bridge therapy. Tinzaparin may be considered for cross-coverage of high-risk patients with recent or recurrent venous thromboembolism who have a creatinine clearance of at least 20 ml/minute.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".