The appropriateness of enoxaparin use in Lebanese hospitals: a quality evaluation study

Zeitoun, Abeer; Nassif, Jeanette G.; Zeineddine, Maya

doi:10.1007/s11096-011-9559-1

Cited by 3 publications

(4 citation statements)

References 40 publications

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“…14 Similar to in-hospital studies, rates of regimen compliance are higher in thrombosis prophylaxis than in curative indications. 14,15 However, the interpretation of regimen compliance should be cautious in patients with therapeutic indication, since dosages could have been adapted after results of biological monitoring (activated partial thromboplastin time for UHs or anti-Xa activity for LWMHs). Also, we chose a stringent range for compliance with dose (±0.05 mL, based on clinicians’ experience).…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of adverse events related to parenteral anticoagulants therapy (5.4%) is also in range with previous studies (3.7%-5%). 14,15 Bleedings (0.6% of patients) remain the most frequent serious adverse events related to parenteral anticoagulants therapy. However, our sample size was insufficient to assess the association between compliance with SPCs/guidelines and adverse events related to parenteral anticoagulants.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10][11][12] Several observational studies have assessed the compliance of parenteral anticoagulants use in hospital settings. [13][14][15][16] These studies suggested that quality and safety of parenteral anticoagulants use are warranted in most of inpatients. However, to our knowledge, no study has assessed this issue in primary care settings.…”

Section: Introductionmentioning

confidence: 99%

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Parenteral Anticoagulants Use in General Practice

Courrier

Fournier

Sommet

et al. 2014

Clin Appl Thromb Hemost

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Using parenteral anticoagulants in compliance with their summaries of product characteristics (SPCs) and consensus guidelines is associated with decreased rates of adverse drug reactions. The objectives were to assess compliance of parenteral anticoagulants use with SPCs and 4 consensus guidelines in outpatients of general practice. A descriptive cross-sectional study was conducted among 112 teaching general practitioners' offices, from May to October 2011. Among the 332 adult outpatients consecutively included, 108 (32.5%) had a parenteral anticoagulant therapy complying with SPCs for both indication and regimen. The rate of compliance increased when considering consensus guidelines (159 patients, 47.9%). Rate of adverse events was 5.4%, including 0.6% of serious adverse events. This study showed that the use of parenteral anticoagulants complies with indications and regimens of SPCs in only 1 of the 3 outpatients. Further studies should be conducted in primary care to explore reasons for such low compliance rates.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Parenteral Anticoagulants Use in General Practice

Courrier

Fournier

Sommet

et al. 2014

Clin Appl Thromb Hemost

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“…In a retrospective study that evaluated the appropriateness of enoxaparin use, it was reported that 40% of the 463 study participants from Lebanese hospitals received improper enoxaparin dosing [10][11][12][13][14][15]. This was mostly observed in the VTE prophylaxis group.…”

Section: Introductionmentioning

confidence: 99%

Drug Utilization Evaluation (DUE) on Enoxaparin in Venous Thromboembolism (VTE) Prophylaxis for Hip and Knee Replacement Surgery

Chung¹,

Ng²,

Lai³

2017

J Mol Biomark Diagn

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Aim: The study aims to assess the adequacy and appropriateness of the use of chemical prophylaxis/enoxaparin in total knee and/or hip replacement (TKR and THR) surgery patients at National University Hospital (NUH) with respect to the compliance/non-compliance to NUH Venous-Thromboembolism (VTE) Prophylaxis Guidelines. This is done with the objective to identify potential gaps in current prescribing patterns that may require interventions to improve clinical efficacy and safety outcomes. Methodology:A retrospective drug utilization evaluation was performed for NUH patients aged≥18 years old who have undergone TKR and/or THR surgery from 1st January to 31st May 2013 and excluded foreigners not residing in Singapore. The study indicators included compliance of chemoprophylaxis/enoxaparin prescribing patterns to NUH guidelines. Efficacy and safety related clinical outcomes in terms of VTE and hemorrhagic events respectively in a 3-months follow-up period post-surgery were also measured.Results: A total of 127 patients were available for evaluation but data for 82 patients were collected and analyzed. Chemoprophylaxis prescribing patterns for only 46 (56.1%) patients were compliant to NUH guidelines in terms of indication. The need for chemoprophylaxis exceeded bleeding risks for 55 (67.1%) patients but only 30 (36.6%) patients were given chemoprophylaxis (enoxaparin). When enoxaparin was prescribed, none of the dosing regimens were compliant to NUH guidelines in all aspects of dose and frequency, prophylaxis duration and time of first dose initiation. During the 3-months follow-up, no bleeding events due to enoxaparin occurred. 9 (11.0%) patients developed thrombosis, 2 of which considered as clinically significant by physicians. Conclusion:The study revealed the baseline chemoprophylaxis and enoxaparin usage patterns in NUH TKR and THR patients. The adverse clinical outcomes that occurred identified potential safety gaps within the prescribing practices, for which recommendations were made to improve the safe and effective use of VTE chemoprophylaxis in NUH post-surgical orthopedic patients.

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Digital clinical decision support to improve pharmacotherapy in (morbidly) obese patients: a prospective intervention study.

Keyany,

Groenen,

Saini

et al. 2023

Preprint

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Background In (morbidly) obese patients standard medication dosing is suboptimal and requires adjustments to body mass index (BMI) or body weight (BW). Digital clinical decision support (eCDS) may help optimise this. Aim To assess the effect of eCDS on adjustments to BMI/BW in pharmacotherapy in hospitalised (morbidly) obese patients. Method This prospective intervention study included hospitalised patients ≥18years with a BMI ≥30kg/m² and/or BW ≥90kg from 01.01.2022-30.09.2022 (pre-eCDS) and from 10.10.2022-25.11.2022 (post-eCDS). Post-eCDS, pharmacy recommended dose adjustments to physicians based on eCDS, a tool that selected patients whose medication order(s) needed adjustment to BMI/BW. Study outcomes were prevalence of medication orders adjusted to BMI/BW pre-eCDS versus post-eCDS, prevalence of post-eCDS patients with ≥1 medication order(s) with a recommendation for adjustment, physician acceptance rate, including reasons for rejection, and occurrence of treatment failure/adverse events. Results In post-eCDS patients (n=804) pharmacotherapy was significantly more often adjusted to BMI/BW than in pre-eCDS patients (n=4,428): 77.7% (912/1,173 medication orders) post-eCDS versus 58.2% (3,519/6,049 medication orders) pre-eCDS (p<0.0001). Post-eCDS, 328 patients had ≥1 medication order(s) resulting in 349 pharmacotherapeutic recommendations. The acceptance rate by physicians was 53.3% (186/349 for 167 patients). The recommendations mainly concerned nadroparin [92.8% (324/349)] and antibiotics [6.9% (24/349)]. The main reason for rejecting a recommendation was near discharge [90.8% (148/163)]. No treatment failures and four possible adverse events occurred. Conclusion Implementation of eCDS significantly increased the prevalence of medication orders adjusted to BMI/BW in hospitalised (morbidly) obese patients and is useful to optimise treatment for this growing population.

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The appropriateness of enoxaparin use in Lebanese hospitals: a quality evaluation study

Abstract: This study highlighted the improper practice and thus the need of implementation of clinical practice guidelines for the dosing of enoxaparin, in Lebanese hospitals.

Cited by 3 publications

References 40 publications

Parenteral Anticoagulants Use in General Practice

Parenteral Anticoagulants Use in General Practice

Drug Utilization Evaluation (DUE) on Enoxaparin in Venous Thromboembolism (VTE) Prophylaxis for Hip and Knee Replacement Surgery

Digital clinical decision support to improve pharmacotherapy in (morbidly) obese patients: a prospective intervention study.

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