June 1, 2005Clinical Pharmacology & Therapeutics
Dosing strategy in patients with renal failure receiving enoxaparin for the treatment of non-ST-segment elevation acute coronary syndrome
Key result
Enoxaparin clearance decreased by 31% in moderate and 44% in severe renal impairment, suggesting a dose reduction to 0.8 mg/kg/12h and 0.66 mg/kg/12h, respectively, to avoid accumulation.
Why the study?
Does renal impairment alter enoxaparin clearance and what is the optimal dosing strategy in patients with acute coronary syndrome?
Population
532 patients with acute coronary syndrome
Design
Cohort
Authors
Discussion
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Implication
May warrant caution with standard dosing in renal impairment; hypothesis-generating for adjusted regimens in ACS pending randomized validation.
Study Design
Type
Observational (n=532)
Structured PICO
Does renal impairment alter enoxaparin clearance and what is the optimal dosing strategy in patients with acute coronary syndrome?
P
Population
532 patients with acute coronary syndrome (normal renal function in 34%, mild renal impairment in 36%, moderate renal impairment in 20%, and severe renal impairment in 10%)
I
Intervention
Subcutaneous enoxaparin (mean weight-corrected dose 0.83 +/- 0.19 mg/kg/12h)
O
Outcome
Anti-Xa activities, enoxaparin clearance, and volume of distributionsurrogate
Enoxaparin dosage should be reduced in acute coronary syndrome patients with creatinine clearance lower than 50 mL/min to avoid significant accumulation, with specific adjusted regimens proposed based on pharmacokinetic modeling.
Cite This Study
Hulot et al. (2005) conducted an observational in non-ST-segment elevation acute coronary syndrome (n=532). Enoxaparin was evaluated on Enoxaparin clearance and anti-Xa activities. Enoxaparin clearance decreased by 31% in moderate and 44% in severe renal impairment, suggesting a dose reduction to 0.8 mg/kg/12h and 0.66 mg/kg/12h, respectively, to avoid accumulation.