Danaparoid for XXXX : an analysis of treatment failures.

@entity1 @entity882 @entity39 @entity1151 @entity5642 @entity1031 @entity741 @entity65 @entity715 @entity10269
BACKGROUND: @entity1 with @entity882 ( @entity882 ) (with or without @entity715 ) require alternative anticoagulation because of their extreme risk of new @entity1031 . The first effective agent for this purpose may be danaparoid, a less-sulfated low molecular weight heparinoid. Recently, direct thrombin inhibitors have been used. OBJECTIVE: Five @entity882 @entity1 , who developed new @entity1031 while receiving @entity10269 , were analyzed to consider possible reasons for treatment failure and to promulgate strategies that improve efficacy. RESULTS: Three @entity1 had acute @entity882 , one had recent @entity882 , and one with remote @entity882 was re-exposed to heparin during heart surgery. Danaparoid was started as intravenous bolus and infusion in one @entity1 , and as 1250 units subcutaneously twice daily in four @entity1 . The new complications that emerged on danaparoid were new venous thrombi in three @entity1 (one with @entity1151 ), lower extremity arterial @entity715 in one, @entity741 in one, @entity1031 @entity65 in one, and @entity39 in one (two @entity1 suffered more than one complication). Platelet counts did not improve or worsened in four, improved partially in the other, and parameters of disseminated @entity5642 failed to improve in one @entity1 . Four @entity1 responded relatively dramatically when direct thrombin inhibitors were substituted. Possible reasons for danaparoid failure include that: 1) no treatment is expected to completely prevent complications, 2) antithrombin III consumption can blunt efficacy in some @entity1 , 3) low or intermediate doses may be insufficient, and 4) there was clinically significant cross-reactivity of the pathogenic @entity882 antibodies. CONCLUSIONS: It is emphasized that the possibility of clinically significant antibody cross-reactivity and that low or intermediate dosage may be inadequate when using danaparoid in therapy of @entity882 . The latter problem probably extrapolates to other anticoagulants used for @entity882 .
