Prescribing Patterns and Outcomes of Enoxaparin for Anticoagulation of Atrial Fibrillation

Abstract

At a single hospital, wide variation in enoxaparin prescribing patterns existed. Further study is necessary to elucidate more fully the appropriate dosing strategy for this agent in the treatment of atrial fibrillation.

Increased major bleeding risk in patients with kidney dysfunction receiving enoxaparin: a meta-analysis

“…All studies were written in English and included between 18 and 19,655 patients. Four studies were retrospective [20,21,23,31] and 12 prospective [2, 5, 6, 8, 14-17, 24, 25, 29, 32]. Creatinine clearance was calculated in 12 studies by the Cockcroft-Gault formula [2, 5, 14, 16, 17, 20, 21, 23-25, 31, 32] and in two studies by the Modification of Diet in Renal Disease (MDRD) formula [6,14].…”

“…Five studies reduced the dose for patients with a GFR <30 ml/min [14-16, 21, 29], one study adjusted the dose for those with a GFR <60 ml/min empirically to the anti-Xa levels [8], and one study did not mention the precise protocol for dose adjustment in renally impaired patients [20].…”

“…Not all studies divided patients into all stages of renal dysfunction, and so not all 16 studies could always be considered. Thirteen studies were identified that examined patients with a GFR <30 ml/min compared with >30 ml/min [2,5,6,8,14,16,17,20,21,23,25,29,31].…”

Bleeding and Thrombosis in High-Risk Renal Transplantation Candidates Using Heparin

“…11 Furthermore, low-molecular-weight heparin is renally eliminated, bleeding risk is enhanced with renal insufficiency, and the optimal dose of the drug in renal failure is not known, even though some studies have documented reduction in thrombosis. 15,16,25 Other studies used low doses of subcutaneous heparin and found no benefit for thrombosis prevention, although bleeding was increased in some cases. 12-14 Aspirin showed promising results in one study.…”

Antithrombotic strategies for the management of non-valvular atrial fibrillation

“…Further analysis of the data demonstrated that bleeding caused cardioversion to be cancelled or postponed significantly more frequently among conventionally managed patients [34]. In contrast, it has to be kept in mind that recurrent AF following cardioversion is a well-documented problem, with an early study demonstrating that only 42% and 27% of patients maintain sinus rhythm after 1 or 4 years following serial cardioversion, respectively [35]. In the more recent AFFIRM study, only 60% of patients in the rhythm control group maintained sinus rhythm after 3.5 years [13].…”