Division of Cardiovascular Medicine, Department of Medicine
Cardiovascular Diseases | Female Urogenital Diseases and Pregnancy Complications | Geriatrics | Male Urogenital Diseases | Medical Pharmacology | Medical Toxicology | Pharmaceutical Preparations | Therapeutics | Urogenital System
BACKGROUND: Thromboprophylaxis dosing strategies using enoxaparin in elderly patients with renal disease are limited, while dose adjustments or monitoring of anti-Xa levels are recommended. We sought to evaluate the efficacy and safety of enoxaparin 20 mg versus 30 mg subcutaneously daily by comparing anti-Xa levels, thrombosis and bleeding.
METHODS: We conducted a prospective, single-blinded, single-center randomized clinical trial including non-surgical patients, 70 years of age or older, with renal disease requiring thromboprophylaxis. Patients were randomized to receive either 20 mg or 30 mg of enoxaparin. The primary endpoint was peak anti-Xa levels on day 3. Secondary endpoints included trough anti-Xa levels on day 3, achievement of within range prophylactic target peak anti-Xa levels and the occurrence of hemorrhage, thrombosis, thrombocytopenia or hyperkalemia during hospitalization.
RESULTS: Thirty-two patients were recruited and sixteen patients were randomized to each arm. Mean peak anti-Xa level was significantly higher in 30 mg arm (n = 13) compared to the 20 mg arm (n = 11) 0.26 +/- 0.11, 95%CI (0.18-0.34), versus 0.14 +/- 0.09, 95CI (0.08-0.19) UI/ml, respectively; p = 0.004. Mean trough anti-Xa level was higher in 30 mg arm (n = 10) compared to the 20 mg arm (n = 16), 0.06 +/- 0.03, 95CI (0.04-0.08) versus 0.03 +/- 0.03, 95CI (0.01-0.05) UI/ml, respectively; p = 0.044. Bleeding events reported in the 30 mg arm were one retroperitoneal bleed requiring multiple transfusions, and in the 20 mg arm one hematuria. No thrombotic events were reported.
CONCLUSION: Peak anti-Xa levels provided by enoxaparin 20 mg were lower than the desired range for thromboprophylaxis in comparison to enoxaparin 30 mg.
TRIAL REGISTRATION: The trial was retrospectively registered on ClinicalTrials.gov identifier: NCT03158792 . Registered: May 18, 2017.
Anti-Xa, Elderly, Enoxaparin, Renal impairment, Thromboprophylaxis, Venous thromboembolism
Rights and Permissions
© The Author(s). 2019 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
DOI of Published Version
BMC Pharmacol Toxicol. 2019 May 7;20(1):27. doi: 10.1186/s40360-019-0308-8. Link to article on publisher's site
BMC pharmacology and toxicology
Chamoun N, Ghanem H, Hachem A, Hariri E, Lteif C, Mansour H, Dimassi H, Zalloum R, Ghanem G. (2019). Evaluation of prophylactic dosages of Enoxaparin in non-surgical elderly patients with renal impairment. Open Access Articles. https://doi.org/10.1186/s40360-019-0308-8. Retrieved from https://escholarship.umassmed.edu/oapubs/3842
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Cardiovascular Diseases Commons, Female Urogenital Diseases and Pregnancy Complications Commons, Geriatrics Commons, Male Urogenital Diseases Commons, Medical Pharmacology Commons, Medical Toxicology Commons, Pharmaceutical Preparations Commons, Therapeutics Commons, Urogenital System Commons