7th Annual WML Academic Symposium

Presenter(s): Katherine Cook, April Cooper, Kevin Cowart, Talal Dahhan, and Catherine Wente
Title: Subtherapeutic anti-Xa levels in a patient with cirrhosis receiving low molecular weight heparin for deep vein thromboses
Developed under the guidance of Dr. Catherine Wente , PharmacyPractice

Cirrhosis of the liver is associated with both procoagulant and anticoagulant states, creating a unique challenge when anticoagulation is required. We present a case of a 35 year old cirrhotic male admitted for severe bilateral lower extremity cellulitis and found to have bilateral deep vein thromboses (DVTs). Treatment with low molecular weight heparin (LMWH) was initiated and anti-Xa levels were found to be consistently low. A literature review revealed that the severity of liver disease is negatively correlated with anti-Xa levels. This suggests that dosing LMWH based on anti-Xa levels was an inaccurate method of monitoring anticoagulant therapy.