Anticoagulation in special patient populations: Are special dosing considerations required?
Franklin Michota, MD
Section of Hospital Medicine, Department of General Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH
Geno Merli, MD
Division of Internal Medicine, Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, PA
Correspondence: Franklin Michota, MD, Department of General Internal Medicine, E13, Cleveland Clinic Foundation, Cleveland, OH 44195; email@example.com
Dr. Michota has received grant/research support from Sanofi-Aventis and is a consultant for Sanofi-Aventis and Pfizer.
Dr. Merli has received grant/research support from Sanofi-Aventis, AstraZeneca, and Bristol-Myers Squibb, and is a consultant for and on the speakers' bureaus of Sanofi-Aventis and AstraZeneca.
Optimal dosing of low-molecular-weight heparin (LMWH) therapy has not yet been established for patients with morbid obesity or renal insufficiency or for pregnant women. Monitoring of anti-Xa levels appears to be helpful in guiding LMWH dosing in all of these patient groups. Use of fondaparinux in these populations has yet to be defined. Cancer patients are at particular risk of venous thromboembolism and generally require escalated and/or prolonged anticoagulation with intense monitoring of therapy.