Efficacy of prophylactic anticoagulation with enoxaparin in ICU patients measured by antiXa activity: a retrospective study

Kód výsledku v IS VaVaI

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Výsledek na webu

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DOI - Digital Object Identifier

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Jazyk výsledku

angličtina

Název v původním jazyce

Efficacy of prophylactic anticoagulation with enoxaparin in ICU patients measured by antiXa activity: a retrospective study

Popis výsledku v původním jazyce

INTRODUCTION. Standard dose of 40 mg of enoxaparin subcutaneously once a day is so far recommended for prophylactic anticoagulation in all patients regardless their weight and physical status although it has been shown in ICU patients in numerous studies to be unreliable and not effective enough according to antiXa activity. Evidence suggests decreased bioavailability of enoxaparin in ICU population.We have started testing antiXa activity routinely in our ICU patients after every enoxaparin given for prophylactic anticoagulation in 2013. The dosing of enoxaparin is adjusted according to antiXa activity in each patient. The initial dose used in our ICU is 40 mg in most patients, higher initial dose is used mostly in obese patients, but the initial dosage is left to the ICU physician, we do not have a set protocol. OBJECTIVES. Evaluation of the efficacy of prophylactic anticoagulation with dosing of enoxaparin guided by routine testing of antiXa activity. METHODS. Data was retrospectively collected from patients admitted to our 9 bed mixed ICU over 3 months period (1.4.- 30.6.2016). Included were all patients on prophylactic anticoagulation by subcutaneously administered enoxaparin in whom antiXa activity was measured. AntiXa activity is measured 3 hours after the subcutaneous application of enoxaparin in our institution, the recommended prophylactic range of antiXa activity is 0,2-0,5 U/ml. RESULTS. 49 patients who met the set criteria were admitted during the 3 month study period to our ICU. 284 antiXa measurements were taken, 190 (66,9%) were within the prophylactic range (0,2-0,5 U/ml), 80 (28,2%) were under the prophylactic range and 14 were over the prophylactic range. 40 mg of enoxaparin was used 118 times (41,5%), 60 mg 106x (37,3%), 80 mg 45x (15,8%),100 mg 5x (1,8%) and 20 mg 10x (3,5%). The initial dose of enoxaparin was 40 mg in 40 patients, in 19 antiXa was within prophylactic range, in 19 was antiXa activity too low and in 2 patients was antiXa activity too high. The initial dose was 60 mg in 8 patients, in 5 patients antiXa activity was within the recommended range and in 3 patients it was too low. The initial dose was 80 mg in one patient with antiXa activity within prophylactic range. In summary the initial dose was correct in 25 patients, it was too low in 22 patients and too high in 2 patients.CONCLUSIONS. Prophylactic anticoagulation in critically ill patients is essential but poses many problems. The standard recommended dosage is often not sufficient, in our study standard dosing was used only in 41,5%. Even though we used higher dosage than recommended in 54,9%, the antiXa activity was adequate only in 66,9%. The bioavailability of enoxaparin changes in a patient during his critical illness. The initial dose of enoxaparin should also be individualized. Monitoring of antiXa activity seems to be essential but even routine monitoring is not the only answer. More studies need to be done.

Název v anglickém jazyce

Efficacy of prophylactic anticoagulation with enoxaparin in ICU patients measured by antiXa activity: a retrospective study

Popis výsledku anglicky

INTRODUCTION. Standard dose of 40 mg of enoxaparin subcutaneously once a day is so far recommended for prophylactic anticoagulation in all patients regardless their weight and physical status although it has been shown in ICU patients in numerous studies to be unreliable and not effective enough according to antiXa activity. Evidence suggests decreased bioavailability of enoxaparin in ICU population.We have started testing antiXa activity routinely in our ICU patients after every enoxaparin given for prophylactic anticoagulation in 2013. The dosing of enoxaparin is adjusted according to antiXa activity in each patient. The initial dose used in our ICU is 40 mg in most patients, higher initial dose is used mostly in obese patients, but the initial dosage is left to the ICU physician, we do not have a set protocol. OBJECTIVES. Evaluation of the efficacy of prophylactic anticoagulation with dosing of enoxaparin guided by routine testing of antiXa activity. METHODS. Data was retrospectively collected from patients admitted to our 9 bed mixed ICU over 3 months period (1.4.- 30.6.2016). Included were all patients on prophylactic anticoagulation by subcutaneously administered enoxaparin in whom antiXa activity was measured. AntiXa activity is measured 3 hours after the subcutaneous application of enoxaparin in our institution, the recommended prophylactic range of antiXa activity is 0,2-0,5 U/ml. RESULTS. 49 patients who met the set criteria were admitted during the 3 month study period to our ICU. 284 antiXa measurements were taken, 190 (66,9%) were within the prophylactic range (0,2-0,5 U/ml), 80 (28,2%) were under the prophylactic range and 14 were over the prophylactic range. 40 mg of enoxaparin was used 118 times (41,5%), 60 mg 106x (37,3%), 80 mg 45x (15,8%),100 mg 5x (1,8%) and 20 mg 10x (3,5%). The initial dose of enoxaparin was 40 mg in 40 patients, in 19 antiXa was within prophylactic range, in 19 was antiXa activity too low and in 2 patients was antiXa activity too high. The initial dose was 60 mg in 8 patients, in 5 patients antiXa activity was within the recommended range and in 3 patients it was too low. The initial dose was 80 mg in one patient with antiXa activity within prophylactic range. In summary the initial dose was correct in 25 patients, it was too low in 22 patients and too high in 2 patients.CONCLUSIONS. Prophylactic anticoagulation in critically ill patients is essential but poses many problems. The standard recommended dosage is often not sufficient, in our study standard dosing was used only in 41,5%. Even though we used higher dosage than recommended in 54,9%, the antiXa activity was adequate only in 66,9%. The bioavailability of enoxaparin changes in a patient during his critical illness. The initial dose of enoxaparin should also be individualized. Monitoring of antiXa activity seems to be essential but even routine monitoring is not the only answer. More studies need to be done.

Druh

O - Ostatní výsledky

CEP obor

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OECD FORD obor

30223 - Anaesthesiology

Projekt

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Návaznosti

I - Institucionalni podpora na dlouhodoby koncepcni rozvoj vyzkumne organizace

Rok uplatnění

2017

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů