Impact of augmented renal clearance on enoxaparin therapy in critically ill patients

Naeem, Hala Ezzat Mohamed Abdel El; Abdelhamid, Mona Hossam Eldin; Atteya, Dina Atteya Mohamed

doi:10.1016/j.egja.2016.11.001

Cited by 22 publications

(12 citation statements)

References 23 publications

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“…Accordingly, Higher initial levetiracetam doses (1 g IV every 8 h) have been suggested in patients with high risk for ARC [ 42 , 54 ]. Enoxaparin, a low molecular weight heparin, also has been reported to be affected by presence of ARC suggested the need for more rigorous monitoring of anti-factor Xa activity in patients with ARC [ 5 ].…”

Section: Resultsmentioning

confidence: 99%

Augmented Renal Clearance in Critical Illness: An Important Consideration in Drug Dosing

2017

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Augmented renal clearance (ARC) is a manifestation of enhanced renal function seen in critically ill patients. The use of regular unadjusted doses of renally eliminated drugs in patients with ARC might lead to therapy failure. The purpose of this scoping review was to provide and up-to-date summary of the available evidence pertaining to the phenomenon of ARC. A literature search of databases of available evidence in humans, with no language restriction, was conducted. Databases searched were MEDLINE (1946 to April 2017), EMBASE (1974 to April 2017) and the Cochrane Library (1999 to April 2017). A total of 57 records were included in the present review: 39 observational studies (25 prospective, 14 retrospective), 6 case reports/series and 12 conference abstracts. ARC has been reported to range from 14 to 80%. ARC is currently defined as an increased creatinine clearance of greater than 130 mL/min/1.73 m2 best measured by 8–24 h urine collection. Patients exhibiting ARC tend to be younger (<50 years old), of male gender, had a recent history of trauma, and had lower critical illness severity scores. Numerous studies have reported antimicrobials treatment failures when using standard dosing regimens in patients with ARC. In conclusion, ARC is an important phenomenon that might have significant impact on outcome in critically ill patients. Identifying patients at risk, using higher doses of renally eliminated drugs or use of non-renally eliminated alternatives might need to be considered in ICU patients with ARC. More research is needed to solidify dosing recommendations of various drugs in patients with ARC.

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Section: Resultsmentioning

confidence: 99%

Augmented Renal Clearance in Critical Illness: An Important Consideration in Drug Dosing

2017

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“…The development of ARC significantly impacts the PK of many drugs and potentially leads to alterations in plasma concentrations of renally excreted drugs important in ICU such as antibiotics, enoxaparin, and anti-epileptics. 2 , 7 This situation may not be immediately obvious as few ICUs routinely measure CrCl and estimated measures of GFR have been shown to correlate poorly with CrCl. 2 , 12 , 18 Our ICU admits predominantly post-operative patients, patients with sepsis, and patients with pancreatitis.…”

Section: Discussionmentioning

confidence: 99%

“…2 Despite variations in the exact CrCl value to be used, there is evidence to suggest that CrCl >130 mL/ minute/1.73 m 2 can lead to subtherapeutic plasma concentrations of drugs such as antibiotics, in particular beta-lactams, glycopeptides, and aminoglycosides, as well as anticoagulants and antiepileptic medications. 6,7 This observation has led to a general consensus that CrCl >130 mL/ minute/1.73 m 2 is an acceptable and clinically important cut off value for the definition of ARC. 2,5,8 A recent systematic review estimated the prevalence of ARC at 20% to 65% of admissions to the intensive care unit (ICU).…”

Section: Introductionmentioning

confidence: 99%

Augmented renal clearance: a retrospective, cohort study of urinary creatinine clearance in critically ill patients in the United Kingdom

et al. 2021

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Objective Augmented renal clearance (ARC) is associated with sub-therapeutic antibiotic, anti-epileptic, and anticoagulant serum concentrations leading to adverse patient outcomes. We aimed to describe the prevalence and associated risk factors for ARC development in a large, single-centre cohort in the United Kingdom. Methods We conducted a retrospective observational study of critically unwell patients admitted to intensive care between 2014 and 2016. Urinary creatinine clearance was used to determine the ARC prevalence during the first 7 days of admission. Repeated measures logistic regression was used to determine risk factors for ARC development. Results The ARC prevalence was 47.0% (95% confidence interval [95%CI]: 44.3%–49.7%). Age, sex, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and sepsis diagnosis were significantly associated with ARC. ARC was more prevalent in younger vs. older (odds ratio [OR] 0.95 [95%CI: 0.94–0.96]), male vs. female (OR 0.32 [95%CI: 0.26–0.40]) patients with lower vs. higher APACHE II scores (OR 0.94 [95%CI: 0.92–0.96]). Conclusions This patient group probably remains unknown to many clinicians because measuring urinary creatinine clearance is not usually indicated in this group. Clinicians should be aware of the ARC risk in this group and consider measurement of urinary creatinine clearance.

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“…Finally, there are no definitive recommendations for the adaptation of LMWH in patients with augmented renal clearance [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Management of COVID-19 Coagulopathy in a Patient with Severe Haemophilia A

et al. 2020

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A 54-year-old man with a long history of severe haemophilia A treated prophylactically with efmoroctocog alpha (3,000 IU twice weekly) was diagnosed with COVID-19 infection. He had multiple risk factors for COVID-19 severity including obesity, diabetes mellitus and hypertension. He required prolonged intensive care unit (ICU) stay due to the severity of respiratory failure until his death on day 24. During his ICU stay, he received a continuous infusion of efmoroctocog alpha in order to maintain factor VIII activity between 80 and 100%, together with therapeutic doses of low-molecular-weight heparin targeting anti-Xa activity above 0.5 IU/mol. He tolerated numerous invasive procedures without bleeding. At post-mortem examination, there was no evidence for thrombosis or haemorrhage in the different organs.

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Impact of augmented renal clearance on enoxaparin therapy in critically ill patients

Cited by 22 publications

References 23 publications

Augmented Renal Clearance in Critical Illness: An Important Consideration in Drug Dosing

Augmented Renal Clearance in Critical Illness: An Important Consideration in Drug Dosing

Augmented renal clearance: a retrospective, cohort study of urinary creatinine clearance in critically ill patients in the United Kingdom

Management of COVID-19 Coagulopathy in a Patient with Severe Haemophilia A

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