Plasma anti-FXa concentration after continuous intravenous infusion and subcutaneous dosing of enoxaparin for thromboprophylaxis in critically ill patients. A randomized clinical trial

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Vahtera , A , Valkonen , M , Huhtala , H , Pettila , V & Kuitunen , A 2017 , ' Plasma anti-FXa concentration after continuous intravenous infusion and subcutaneous dosing of enoxaparin for thromboprophylaxis in critically ill patients. A randomized clinical trial ' , Thrombosis Research , vol. 158 , pp. 71-75 . https://doi.org/10.1016/j.thromres.2017.08.014

Title: Plasma anti-FXa concentration after continuous intravenous infusion and subcutaneous dosing of enoxaparin for thromboprophylaxis in critically ill patients. A randomized clinical trial
Author: Vahtera, Annukka; Valkonen, Miia; Huhtala, Heini; Pettila, Ville; Kuitunen, Anne
Contributor: University of Helsinki, Clinicum
University of Helsinki, Clinicum
Date: 2017-10
Language: eng
Number of pages: 5
Belongs to series: Thrombosis Research
ISSN: 0049-3848
URI: http://hdl.handle.net/10138/298165
Abstract: Introduction: In intensive care unit (ICU) patients, subcutaneous low-molecular weight heparin thromboprophylaxis results in lower plasma anti-factor Xa (anti-FXa) levels compared to general ward patients. The aim of this study was to examine whether enoxaparin thromboprophylaxis given as a continuous intravenous infusion (CII) results in more constant and predictable anti-FXa concentration than standard subcutaneous bolus (SCB) administration. Materials and methods: This was a prospective, single-blind, multicenter, randomized controlled trial where ICU patients requiring thromboprophylaxis received enoxaparin either 40 mg as a SCB once daily or 40 mg as a CII over 24 h for three consecutive days. The primary outcome was maximum serum anti-FXa concentration (C-max24 (h)) within the first 24 h; the secondary outcome was anti-FXa area under the curve (AUC)((0-24 h)). Trough level was measured at 72 h. Results: Thirty-nine patients were included in the intention to treat analysis. The median anti-FXa C-max24 (h) was 0.05 (interquartile range, IQR, 0.05-0.18) IU/ml in the CII group and 0.18 (IQR, 0.12-0.33) IU/ml in the SCB group (p= 0.05). Median anti-FXa AUC((0-24 h)) was 1.20 (IQR, 0.98-2.88) in the CII and 1.54 (IQR, 1.22-4.12) in the SCB group (p = 0.095). After 72 h, 66.7% of patients in the CII group had a detectable anti-FXa concentration of > 0.1 IU/ml, compared with 16.7% in the SCB group (p = 0.019). Conclusions: Continuous infusion of enoxaparin led to lower anti-FXa C-max24 h than standard SCB administration. No difference in anti-FXa AUC(0-24) (h) was detected.
Subject: Heparin
Low-molecular-weight
Anticoagulants
Enoxaparin
Critical care
Pharmacokinetics
Drug monitoring
MOLECULAR-WEIGHT HEPARIN
DEEP VENOUS THROMBOSIS
ED AMERICAN-COLLEGE
XA ACTIVITY
ANTITHROMBOTIC THERAPY
PRACTICE GUIDELINES
SURGICAL-PATIENTS
SEPTIC PATIENTS
SCORING SYSTEM
TRAUMA
3121 General medicine, internal medicine and other clinical medicine
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