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September 22/29, 2004

Fractionating Heparin—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(12):1427-1428. doi:10.1001/jama.292.12.1427-c

In Reply: We appreciate the comments by Dr Arbit, although we disagree with his position that the ratio of anti-factor Xa–anti-factor IIa activity of heparins is meaningless. This ratio is a reflection of polysaccharide chain length distribution, and this distribution affects the rate of heparin clearance and potentially the width of the therapeutic window. Our editorial was focused on the data from the SYNERGY and A to Z trials, rather than details of anti-factor effects of heparins. We believe that this was well addressed in an overview of low-molecular-weight heparins by Weitz.1

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