BACKGROUND: Low-molecular-weight heparin is effective for prevention of venous thromboembolism. The efficacy of daily dosing in critically ill patients is unknown. METHODS: Seventeen critically ill patients on 40 mg of enoxaparin subcutaneously daily were studied. Anti-Xa activity was measured 4 hours after the third dose and before the fourth dose. Adverse events were recorded. RESULTS: Mean peak anti-Xa activity was 0.19 +/- 0.09 International Units/mL and mean trough was 0.044 +/- 0.04 International Units/mL. The recommended target range is 0.1 to 0.2 International Units/mL. The trough was below therapeutic levels in all but two patients. One thrombosis occurred in a patient despite a therapeutic trough. CONCLUSION: Daily dosing of enoxaparin is inadequate for critically ill patients and should be abandoned. Further studies using twice daily dosing are needed. Patients with renal insufficiency may require an increased interval of administration (daily dosing). Anti-Xa levels may not correlate with the risk of thromboembolic complications. Patients with renal insufficiency and morbid obesity may require alternative dosing and monitoring of anti-Xa levels.
BACKGROUND: Low-molecular-weight heparin is effective for prevention of venous thromboembolism. The efficacy of daily dosing in critically illpatients is unknown. METHODS: Seventeen critically illpatients on 40 mg of enoxaparin subcutaneously daily were studied. Anti-Xa activity was measured 4 hours after the third dose and before the fourth dose. Adverse events were recorded. RESULTS: Mean peak anti-Xa activity was 0.19 +/- 0.09 International Units/mL and mean trough was 0.044 +/- 0.04 International Units/mL. The recommended target range is 0.1 to 0.2 International Units/mL. The trough was below therapeutic levels in all but two patients. One thrombosis occurred in a patient despite a therapeutic trough. CONCLUSION: Daily dosing of enoxaparin is inadequate for critically illpatients and should be abandoned. Further studies using twice daily dosing are needed. Patients with renal insufficiency may require an increased interval of administration (daily dosing). Anti-Xa levels may not correlate with the risk of thromboembolic complications. Patients with renal insufficiency and morbid obesity may require alternative dosing and monitoring of anti-Xa levels.
Authors: Molly Elizabeth Droege; Christopher Allen Droege; Carolyn Dosen Philpott; Megan Leslie Webb; Neil Edward Ernst; Krishna Athota; Devin Wakefield; Joseph Richard Dowd; Dina Gomaa; Bryce H R Robinson; Dennis Hanseman; Joel Elterman; Eric William Mueller Journal: J Thromb Thrombolysis Date: 2021-05-12 Impact factor: 2.300
Authors: Joseph F Rappold; Forest R Sheppard; Samuel P Carmichael Ii; Joseph Cuschieri; Eric Ley; Erika Rangel; Anupamaa J Seshadri; Christopher P Michetti Journal: Trauma Surg Acute Care Open Date: 2021-02-24
Authors: Charlotte D C C van der Heijden; Rob Ter Heine; Emma J Kooistra; Roger J Brüggemann; Jesper W J Walburgh Schmidt; Elke P L M de Grouw; Tim Frenzel; Peter Pickkers; Jenneke Leentjens Journal: Br J Clin Pharmacol Date: 2022-01-17 Impact factor: 3.716