Dosage of enoxaparin among obese and renal impairment patients

Bazinet, Annie; Almanric, Karine; Brunet, Catherine; Turcotte, Isabel; Martineau, Josée; Caron, S.; Blais, Normand; Lalonde, Lyne

doi:10.1016/j.thromres.2004.10.004

Cited by 120 publications

(122 citation statements)

References 31 publications

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“…Several trials have shown bleeding complications to be a more powerful predictor of mortality than ischaemic complications such as reinfarction. 21,22 As known from the GRACE registry score for NSTEMI, renal failure is one of the most important predictors for in-hospital mortality and major bleeding. 19 Patients with renal insufficiency form a large portion of the ACS patient population, with a prevalence varying from 13.2% for patients with GFR below 30 ml/min to 42% for patients with GFR between 30 and 70 ml/min.…”

Section: Renal Failurementioning

confidence: 99%

“…25 Patients aged 75 years and above Age above 75 years has been shown to be an independent risk factor for bleeding complications and worse outcome. 21,26 Dose adjustment of LWMH for patients older than 75 years of age is therefore recommended. [26][27][28] Dutch physicians do not routinely adjust anticoagulation dosing for these patients.…”

Section: Renal Failurementioning

confidence: 99%

See 1 more Smart Citation

Guideline adherence for antithrombotic therapy in acute coronary syndrome: an overview in Dutch hospitals

Kikkert

Piek²,

Winter³

et al. 2010

NHJL

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Objective. To assess current Dutch antithrombotic treatment strategies for acute coronary syndrome (ACS) in light of the current European Society of Cardiology (ESC) guidelines. Methods. For every Dutch hospital with a coronary care unit (CCU) (n = 93) a single cardiologist was interviewed concerning heparin, thienopyridine and GP IIb/IIIa inhibitor (GPI) treatment. In each hospital, we randomly approached one cardiologist assuming equal policy among physicians employed at the same hospital.

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Section: Renal Failurementioning

confidence: 99%

Section: Renal Failurementioning

confidence: 99%

Guideline adherence for antithrombotic therapy in acute coronary syndrome: an overview in Dutch hospitals

Kikkert

Piek²,

Winter³

et al. 2010

NHJL

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“…We initially hypothesized that patients with moderate renal impairment may experience an appreciable degree of anticoagulant accumulation, leading to an increased risk of bleeding. Although, previous data has implicated that bioaccumulation of enoxaparin is seen in patients whose CrCl is in the 30-50 ml/min range, this may not be clinically significant in all patients [13]. However, a retrospective review of Veterans affairs data by Decarolis did indeed find an increased bleeding risk in patients with moderate renal impairment compared to those with normal renal function [21].…”

Section: Discussionmentioning

confidence: 94%

“…A 2005 study by Bazinet et al showed significantly supratherapeutic anti Xa levels in patients receiving enoxaparin with moderate renal impairment compared to the normal renal function group (CrCl ≥ 50 ml/min) [13]. Another study by Hulot et al showed 31% decrease in enoxaparin clearance in patients whose CrCl was between 30 and 50 ml/min compared to 17% decrease in the CrCl 50-80 ml/min group [14].…”

Section: Introductionmentioning

confidence: 98%

Risk Factors for Bleeding Events with Enoxaparin, Dabigatran and Fondaparinux in Hospitalized Patients with Varying Levels of Renal Impairment

Ahuja¹,

Altshuler²,

Papadopoulos³

2017

J Pharma Care Health Sys

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“…5 Renal impairment, obesity and pregnancy may influence the dosing requirements of enoxaparin. 6,7 Since the assay can be completed within a 10-min period, it could also be used in a clinic or physician's office, where it would provide information on the adequacy of anticoagulation in patients who are at a risk of development of venous thromboembolism. Immediate dosage adjustments could be instituted, as needed.…”

Section: Discussionmentioning

confidence: 99%

Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood

Inchiosa

Pothula

Kubal

et al. 2012

JoVE

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There is the need for a clinical assay to determine the extent to which a patient's blood is effectively anticoagulated by the low-molecularweight-heparin (LMWH), enoxaparin. There are also urgent clinical situations where it would be important if this could be determined rapidly. The present assay is designed to accomplish this. We only assayed human blood samples that were spiked with known concentrations of enoxaparin. The essential feature of the present assay is the quantification of the efficacy of enoxaparin in a patient's blood sample by degrading it to complete inactivity with heparinase. Two blood samples were drawn into Vacutainer tubes (Becton-Dickenson; Franklin Lakes, NJ) that were spiked with enoxaparin; one sample was digested with heparinase for 5 min at 37 °C, the other sample represented the patient's baseline anticoagulated status. The percent shortening of clotting time in the heparinase-treated sample, as compared to the baseline state, yielded the anticoagulant contribution of enoxaparin. We used the portable, battery operated Hemochron 801 apparatus for measurements of clotting times (International Technidyne Corp., Edison, NJ). The apparatus has 2 thermostatically controlled (37 °C) assay tube wells. We conducted the assays in two types of assay cartridges that are available from the manufacturer of the instrument. One cartridge was modified to increase its sensitivity. We removed the kaolin from the FTK-ACT cartridge by extensive rinsing with distilled water, leaving only the glass surface of the tube, and perhaps the detection magnet, as activators. We called this our minimally activated assay (MAA). The use of a minimally activated assay has been studied by us and others.2-4 The second cartridge that was studied was an activated partial thromboplastin time (aPTT) assay (A104). This was used as supplied from the manufacturer. The thermostated wells of the instrument were used for both the heparinase digestion and coagulation assays. The assay can be completed within 10 min. The MAA assay showed robust changes in clotting time after heparinase digestion of enoxaparin over a typical clinical concentration range. At 0.2 anti-Xa I.U. of enoxaparin per ml of blood sample, heparinase digestion caused an average decrease of 9.8% (20.4 sec) in clotting time; at 1.0 I.U. per ml of enoxaparin there was a 41.4% decrease (148.8 sec). This report only presents the experimental application of the assay; its value in a clinical setting must still be established. Video LinkThe Collection of Blood Samples1. Two blood samples are drawn by vacuum into sodium citrate (0.3 ml 0.109M; 3.2%) buffered Vacutainer tubes (Becton-Dickinson; Franklin Lakes, NJ); the tubes are both pre-spiked with a known concentration of enoxaparin; the blood volume that is drawn is 2.7 ml. The total content is then 3.0 ml. Heparinase Digestion1. The entire contents of the heparinase vial that can be aspirated into a syringe (approximately 0.2 ml; 80% of the vial; 0.8 μg of protein), is transferred to one Vacutainer tube;...

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Dosage of enoxaparin among obese and renal impairment patients

Cited by 120 publications

References 31 publications

Guideline adherence for antithrombotic therapy in acute coronary syndrome: an overview in Dutch hospitals

Guideline adherence for antithrombotic therapy in acute coronary syndrome: an overview in Dutch hospitals

Risk Factors for Bleeding Events with Enoxaparin, Dabigatran and Fondaparinux in Hospitalized Patients with Varying Levels of Renal Impairment

Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood

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