Use of direct oral anticoagulants in ICU patients. Part I – Applied pharmacology

Wahab, Abdul; Patnaik, Rupali; Gurjar, Mohan

doi:10.5114/ait.2021.110607

Cited by 3 publications

(2 citation statements)

References 98 publications

(159 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Using the LMWH assay, the only available assay in our facility, and with the impossibility to calibrate this assay to the fondaparinux standard curve, we targeted a conservative therapeutic level of anti-factor Xa (anti-Xa) activity of 0.6-1.3 Units/ml, which is 20% [12] above the usual therapeutic target for enoxaparin (0.5-1Units/ml [13]).…”

Section: Methodsmentioning

confidence: 99%

Novel fondaparinux protocol for anticoagulation therapy in adults with renal failure and suspected heparin-induced thrombocytopenia: a retrospective review of institutional protocol

Ghaziri

Dehaini

Msheik

et al. 2023

BMC Pharmacol Toxicol

View full text Add to dashboard Cite

Introduction The literature recommends against the use of fondaparinux in patients with kidney failure and dialysis as it may, with repeated dosing, accumulate and put patients at risk of bleeding. The management of patients with thrombosis in the presence of heparin-induced thrombocytopenia HIT requires the introduction of an alternative anticoagulant like bivalirudin or argatroban. When these drugs are not available, fondaparinux, remains the only alternative. In similar scenarios, there are few studies addressing how to administer it. Methods We developed a protocol for fondaparinux in patients with renal failure where pharmacokinetic parameters are altered, and levels changed only after hemodialysis or in cases of residual renal activity. Patients received a full first dose except for high risk of bleeding. We targeted a peak anti-factor Xa activity level of 0.6–1.3 units/ml and changed the subsequent dose accordingly. Furthermore, we monitored the patients for signs of bleeding, a drop in hemoglobin level, or clinical signs of thrombosis. Discussion We described 10 patients with kidney failure and suspected HIT taking fondaparinux. All the patients achieved therapeutic anti-factor Xa activity levels. However, one developed new-onset venous thromboembolism (VTE) despite therapeutic anti-factor Xa levels. Another patient experienced a bleeding episode. We believe that these two patients developed complications due to their medical conditions rather than the use of fondaparinux. Conclusion Fondaparinux can be safely used in kidney failure using our protocol. However, despite its safety profile and relative success, this case series was small. More robust studies need to be conducted prior to drawing conclusions.

show abstract

Section: Methodsmentioning

confidence: 99%

Novel fondaparinux protocol for anticoagulation therapy in adults with renal failure and suspected heparin-induced thrombocytopenia: a retrospective review of institutional protocol

Ghaziri

Dehaini

Msheik

et al. 2023

BMC Pharmacol Toxicol

View full text Add to dashboard Cite

show abstract

“…Coagulation disorders pose a significant challenge in the management of critically ill patients, leading to adverse outcomes [ 1 , 2 ]. Among them, deep vein thrombosis (DVT) and pulmonary embolism are the most significant factors increasing morbidity and mortality in intensive care unit (ICU) patients [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Continuous Veno-Venous Hemodiafiltration on the Efficacy of Administration of Prophylactic Doses of Enoxaparin: A Prospective Observational Study

Aszkiełowicz,

Steckiewicz,

Okrągły

et al. 2023

Pharmaceuticals

View full text Add to dashboard Cite

Background: Critically ill patients frequently require continuous renal replacement therapy (CRRT). During CRRT, particles up to 10 kDa in size, such as enoxaparin, may be removed. The aim of this study was to determine if patients receiving prophylactic doses of enoxaparin and treated with continuous veno-venous hemodiafiltration (CVVHDF) reach prophylactic values of anti-Xa factor activity. Methods: In this observational trial, we compared two groups: 20 patients treated with CVVHDF and 20 patients not treated with CVVHDF. All of them received prophylactic doses of 40 mg of enoxaparin subcutaneously. Anti-Xa factor activity was determined on the third day of receiving a prophylactic dose of enoxaparin. The first blood sample was taken just before the administration of enoxaparin, and other samples were taken 3 h, 6 h, and 9 h after the administration of a prophylactic dose of enoxaparin. Results: At 3 and 6 h after administration of enoxaparin in both groups, we observed a significant increase in anti-Xa factor activity from baseline, with the peak after 3 h of administration. There were no significant differences in the numbers of patients who had anti-Xa factor activity within the prophylactic range between CVVHDF and control groups. Conclusion: CVVHDF has only a mild effect on the enoxaparin prophylactic effect measured by anti-Xa factor activity. Thus, it seems there is no need to increase the dose of enoxaparin for patients requiring CVVHDF.

show abstract

Coagulopathy and Emergent Reversal of Anticoagulation

Wallisch¹,

Kidd²,

Shen³

et al. 2023

Anesthesiology Clinics

View full text Add to dashboard Cite

Use of direct oral anticoagulants in ICU patients. Part I – Applied pharmacology

Cited by 3 publications

References 98 publications

Novel fondaparinux protocol for anticoagulation therapy in adults with renal failure and suspected heparin-induced thrombocytopenia: a retrospective review of institutional protocol

Novel fondaparinux protocol for anticoagulation therapy in adults with renal failure and suspected heparin-induced thrombocytopenia: a retrospective review of institutional protocol

The Impact of Continuous Veno-Venous Hemodiafiltration on the Efficacy of Administration of Prophylactic Doses of Enoxaparin: A Prospective Observational Study

Coagulopathy and Emergent Reversal of Anticoagulation

Contact Info

Product

Resources

About