Dosing practice of low molecular weight heparins and its efficacy and safety in cardiovascular inpatients: a retrospective study in a Chinese teaching hospital

Abstract

BackgroundLow-molecular-weight heparins (LMWHs) are safe and effective anticoagulant options for cardiovascular patients when applied as body weight-adjusted doses. However, there are some barriers that make it difficult to implement weight-adjusted doses in clinical practice. Therefore, it is vital to learn the dosing practices of LMWH and its efficacy and safety in clinical practice.MethodsA retrospective study was conducted in cardiovascular inpatients who had received at least one dose of LMWH during a 6-month period. Appropriateness of LMWH dosing was determined and major clinical outcomes (major adverse vascular events and major bleeding) during hospitalization were evaluated.ResultsA total of 376 admissions representing 364 patients received LMWH treatment. Of these, 17.0% (64/376) of admissions did not have body weight records. Of the 312 admissions included for the outcome study, only 34 cases (10.9%) received the recommended doses of LMWH, while 51 cases (16.3%) received mild underdoses, 223 cases (71.5%) received major underdoses and 4 (1.3%) received excess doses. There were 10 major adverse vascular events, which occurred more often in patients receiving excess doses of LMWH than in patients receiving recommended, mild or major underdoses (50%, 2.9%, 2.0% and 2.7%, respectively, P < 0.001). After multivariable analysis, severe renal insufficiency was an independent risk factor for major adverse vascular events [odds ratio (OR), 31.93; 95% confidence interval (CI), 5.99-170.30; P < 0.001]. No major bleeding was recorded.ConclusionsUnderdose of LMWH is commonly used in cardiovascular inpatients, which was suboptimal according to guidelines. Using LMWH at a fixed, low dose for treatment purposes in patients without severe renal insufficiency was not associated with a higher risk of adverse vascular events in the current study, though larger studies with extended follow-ups are required to fully assess the long-term consequences of LMWH underdosing.

Review of current evidence available for guiding optimal Enoxaparin prophylactic dosing strategies in obese patients—Actual Weight-based vs Fixed

“…There appears to be insufficient evidence to guide clinical practice surrounding the dose selection of enoxaparin when administered to obese or morbidly-obese adult (19) patients for prophylaxis against venous thromboembolism (both Pulmonary Embolism and Deep Vein Thrombosis). The controversy of enoxaparin prophylaxis dosing largely falls under two groups: those advocating for a fixed dosing (5,9,20) and those advocating for a weight- All 11 studies included in Table 1 used laboratory results of Anti-X a activity as their primary outcome, or as one of its primary outcomes. The results, from the 11 studies suggest that there may be a strong relationship between weight and desired Anti-Xa activity levels (52.2%).…”

Associated factors and safety of the rapidly achieving first therapeutic target of warfarin in hospitalized patients: a retrospective cohort study

“…Severe renal insu ciency (RI) was determined by creatinine clearance < 30 ml/min. Creatinine clearance was calculated by the Cockcroft-Gault equation [140 -age (years)] ⋅ weight (kg) ⋅ (0.85 if female) / [72 ⋅ serum creatinine (mg/dl)] [15]. The achieving rst therapeutic target time was de ned as the rst day reaching the INR threshold of 1.8 following the initiation of warfarin during hospitalization.…”

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“…Different coagulation disorders are benefiting from the use of LMWH to initiate anticoagulation like atrial fibrillation, unstable angina, and non-Q-wave myocardial infarction (MI), deep-vein thrombosis, and pulmonary emboli 2 . Enoxaparin has multiple clinical advantages as a more predictable dose response, a longer half-life for outpatient use, no obvious drug or food interactions, and lower risk of osteoporosis 3 .…”

“…The injection site was sterilized with alcohol, and a 27-gauge needle was inserted at 90° angle during 30 seconds after pinching up the skin on the site of injection without aspiration and by holding the skin of the injection site between the thumb and index finger. Area of the bruising was measured 24-48 h after starting therapy with enoxaparin injection till the end of the study (3-day and 5-day duration) by disposable measuring tape as mm 2 . SPSS version 18 was used in the analysis the collected results.…”