Tripodi recommended that the Subcommittee prepare a recommendation in respect of this. Prof. Fareed described the pathophysiology of heparin induced thrombocytopenia and reviewed the methods of detection. He gave a detailed account of thrombin inhibitor monitoring. Dr. Massicotte presented a report on behalf of Dr. Andrews on LMW Heparin monitory in lldsen. She stressed critical pediatric issues which included weight, age, dependency of pharmacokinetics and the necessity of monitoring during long term therapy.
Detailed information is available for two LMWHs.
Monitoring should be undertaken with anti Xa assays 4-6 hours after a subcutaneous dose. If unexplained thrombocytopenia occurs HIT should be considered. Two relevant international clinical studies are underway and should help clarify the issue of LMW heparin monitoring. Prof. Samama considered LMW heparin monitoring in adults. He discussed the clinical indication for treatment with LMWH and stressed that dose responses were unreliable in obese patients, in the elderly, and in those with impaired renal function.