Key result
In a critically ill patient with ascites, subcutaneous enoxaparin administered at the abdominal wall resulted in subtherapeutic anti-factor Xa levels, which improved when switched to the deltoid.
Why the study?
Subcutaneous enoxaparin bioavailability in critically ill patients with ascites is uncertain despite the abdominal site being most preferable in clinical practice.
Does abdominal subcutaneous enoxaparin provide adequate anti-factor Xa levels in critically ill patients with ascites and local edema?
Case Report (n=1)
No
Does abdominal subcutaneous enoxaparin provide adequate anti-factor Xa levels in critically ill patients with ascites and local edema?
Abdominal subcutaneous enoxaparin may have impaired absorption in critically ill patients with ascites and edema, necessitating therapeutic drug monitoring.
Supports caution with abdominal enoxaparin in ascites; hypothesis-generating and requires confirmation before practice change.
Enoxaparin is a low molecular weight heparin that is principally prescribed for the treatment and prevention of thromboembolic disorders. In clinical practice, the abdominal site for subcutaneous enoxaparin administration is most preferable because of its simplicity and safety. However, subcutaneous enoxaparin bioavailability in critically ill patients with ascites is uncertain. According to this case report, the bioavailability and absorption of subcutaneous enoxaparin was potentially impaired in a critically ill patient with ascites and local edema based on the therapeutic drug monitoring of anti-factor Xa levels.
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Tharanon et al. (2022) conducted a case report in Right atrial thrombus in a critically ill patient with massive ascites and end-stage renal disease (n=1). Subcutaneous enoxaparin was evaluated on Anti-factor Xa levels. In a critically ill patient with ascites, subcutaneous enoxaparin administered at the abdominal wall resulted in subtherapeutic anti-factor Xa levels, which improved when switched to the deltoid.
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