Key result
Continuous intravenous infusion of enoxaparin after CABG resulted in significantly lower maximum anti-Xa levels over 0-24 hours compared to subcutaneous bolus (0.15 vs 0.25 IU/ml, p<0.005).
Why the study?
Enoxaparin is widely used for thromboprophylaxis after CABG, but standard subcutaneous bolus injection was hypothesized to yield lower anti-Xa levels than recommended due to reduced bioavailability.
Does continuous intravenous infusion of enoxaparin alter anti-factor X activity levels compared to subcutaneous bolus administration in patients after coronary artery bypass grafting?
RCT (n=40)
randomized
Does continuous intravenous infusion of enoxaparin alter anti-factor X activity levels compared to subcutaneous bolus administration in patients after coronary artery bypass grafting?
Absolute Event Rate: 0.15% vs 0.25%
p-value: p=<0.005
Subcutaneous bolus administration of enoxaparin after CABG provides higher and more sufficient anti-Xa levels compared to continuous intravenous infusion.
Continuous IV enoxaparin was associated with lower peak anti-Xa levels post-CABG; leaves open whether this alters bleeding or thrombotic risk versus subcutaneous dosing.
Background Low‐molecular‐weight heparin enoxaparin is widely used in pharmacological thromboprophylaxis after coronary artery bypass grafting (CABG). The aim of this study was to compare anti‐factor X activity (anti‐Xa) levels when the thromboprophylactic dose of enoxaparin was provided after CABG, with two different administration routes: continuous intravenous infusion (CIV) and subcutaneous bolus (SCB) injection. We hypothesized that the current standard method of SCB administration might lead to lower anti‐Xa levels than recommended in other patient groups, due to reduced bioavailability. Methods In this prospective, randomized, controlled clinical trial, 40 patients scheduled for elective CABG were randomized to receive 40 mg of enoxaparin per day either as CIV or SCB for 72 h. Enoxaparin was initiated 6–10 h after CABG. Anti‐Xa levels were measured 12–14 times during the study period. The primary outcome, that is, the maximum anti‐Xa concentration over 0–24 h ( C max0–24h ), was calculated from these measured values. Secondary outcomes were C max25–72h and the trough concentration of anti‐Xa after 72 h of enoxaparin initiation ( C 72h ). Results Twenty patients were randomized to the CIV‐group and 19 to the SCB‐group. The median anti‐Xa C max0–24h was significantly lower in the CIV‐group than in the SCB‐group: 0.15 [interquartile range (IQR) 0.13–0.19] IU/ml versus 0.25 (IQR 0.18–0.32) IU/ml, p < .005. The median anti‐Xa C max25–72h was 0.12 (IQR, 0.1–0.17) IU/ml versus 0.23 (IQR 0.19–0.31) IU/ml, respectively, p < .005. At 72 h, there was no difference between the groups in their anti‐Xa levels. Conclusions In this low‐risk CABG patient population, SCB administration of a thromboprophylactic dose of enoxaparin provided anti‐Xa levels that are considered sufficient for thromboprophylaxis in other patient groups. CIV administration resulted in lower anti‐Xa levels compared to the SCB route.
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Parviainen et al. (2022) conducted an RCT in coronary artery bypass grafting (n=40). Enoxaparin via continuous intravenous infusion (CIV) vs. Enoxaparin via subcutaneous bolus (SCB) was evaluated on maximum anti-Xa concentration over 0-24 h (Cmax0-24h) (p=<0.005). Continuous intravenous infusion of enoxaparin after CABG resulted in significantly lower maximum anti-Xa levels over 0-24 hours compared to subcutaneous bolus (0.15 vs 0.25 IU/ml, p<0.005).
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