Treatment of Deep Vein Thrombosis in the Pelvis and Leg: Evaluate Thrombophilia First

by Prof. Dr. med. Viola Hach-Wunderle, Prof. Dr. med. Markus Düx, Anja Hoffmann, Dr. med. Florian Präve, Prof. Dr. med. Max Zegelman, Prof. Dr. med. Wolfgang Hach in volume 1–2/2008

In this otherwise excellent CME article, one important fact is missing that would be essential for treating physicians to know. The once-daily dosing of nadroparin as recommended in table 1 seems not to be applicable to the thrombophilic patient without serious implications, according to the product's Summary of Product Characteristics (European Medicines Agency) and „Fachinformation“ (Bundesinstitut für Arzneimittel und Medizinprodukte). Both agencies are cautioning against a once-daily administration "in patients with thrombophilia", where "a twice daily administration of nadroparin should be considered", instead. It follows, therefore, that a single daily dose of nadroparin is an unsuitable means of providing immediate and effective anticoagulation to a large percentage of patients with thromboses, because time-consuming screening for thrombophilia would have to be evaluated first if this drug was to be given in compliance with the above recommendations. This limitation does not apply to any other low-molecular-weight heparin. DOI: 10.3238/arztebl.2008:0344b