Empirically Reduced Dosages of Tinzaparin in Patients with Moderate-to-Severe Renal Insufficiency Lead to Inadequate Anti-Xa Levels
Key result
Preemptive dosage reduction of tinzaparin in patients with moderate-to-severe renal insufficiency led to inadequate anti-Xa levels (<0.85 IU/mL) in 92.3% of patients (p=0.007).
Why the study?
Does preemptive dosage reduction of tinzaparin reduce anti-Xa levels below the therapeutic range in in-hospital patients with moderate-to-severe renal insufficiency?
Population
In-hospital patients with moderate-to-severe renal insufficiency, on therapeutic dosages of tinzaparin.
Comparison
Preemptive dosage reduction of tinzaparin vs Unadjusted therapeutic dosages of tinzaparin
Design
Cohort
Authors
Discussion
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Member takes
Implication
Preemptive tinzaparin reduction was associated with subtherapeutic anti-Xa levels; hypothesis-generating and should not yet change practice or guidelines.
Study Design
Type
Observational
Structured PICO
Does preemptive dosage reduction of tinzaparin reduce anti-Xa levels below the therapeutic range in in-hospital patients with moderate-to-severe renal insufficiency?
P
Population
In-hospital patients (≥18 years) with moderate-to-severe renal insufficiency (MDRD-eGFR <60 mL/min/1.73 m2), on therapeutic dosages of tinzaparin.
I
Intervention
Preemptive dosage reduction of tinzaparin (25% reduction for MDRD-eGFR 30-60 mL/min/1.73 m2 and 50% reduction for MDRD-eGFR <30 mL/min/1.73 m2)
C
Comparator
Unadjusted therapeutic dosages of tinzaparin
O
Outcome
Anti-Xa levels measured using a chromogenic assaysurrogate
Main Result
p-value: p=0.007
Preemptive dosage reduction of tinzaparin in patients with moderate-to-severe renal insufficiency leads to subtherapeutic anti-Xa levels, challenging current guideline recommendations for universal dose reduction of LMWHs in this population.
Cite This Study
Olie et al. (2017) conducted an observational in Moderate-to-severe renal insufficiency. Preemptive dosage reduction of tinzaparin vs. Unadjusted dosages of tinzaparin was evaluated on Anti-Xa activity below therapeutic range (>0.85 IU/mL) (p=0.007). Preemptive dosage reduction of tinzaparin in patients with moderate-to-severe renal insufficiency led to inadequate anti-Xa levels (<0.85 IU/mL) in 92.3% of patients (p=0.007).