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To the Editor: We would like to raise a few concerns about the article by Dr Blazing and colleagues.¹ First, we are interested in the proportion of patients in the unfractionated heparin group who were able to achieve therapeutic anticoagulation with the relatively low-dose anticoagulation regimen. A recent study by Raschke et al² showed inadequate rates of anticoagulation with unfractionated heparin in large trials that compared it with low-molecular-weight heparins. Lack of differences in efficacy or safety could be attributable to underdosing of unfractionated heparins rather than to equivalence. It would also be useful to know the dose adjustment regimen for unfractionated heparin infusion used in such high-risk unstable angina patients receiving multiple antiplatelet agents.

Second, despite limited analyses from large trials³ and recent approval from the US Food and Drug Administration,⁴ the use of weight-based dosing of low-molecular-weight heparin without antifactor Xa levels in morbidly obese patients remains a . . . [Full Text of this Article]

Balavenkatesh Kanna, MD
bvkanna@aol.com

Puneeta Sharma, MD
Weill Medical College of Cornell University
New York, NY

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