October 1, 2020PLoS ONEOpen Access

Dosage reduction of low weight heparin in patients with renal dysfunction: Effects on anti-Xa levels and clinical outcomes

View Full Paper

Ask AI

Bookmark

Why the study?

Dosage reduction and anti-Xa monitoring have been suggested to prevent LMWH bio-accumulation in patients with decreased kidney function, but the effects of pre-emptive reduction and anti-Xa levels on clinical outcomes required investigation.

Does pre-emptive dosage reduction of LMWH lead to adequate anti-Xa levels and affect clinical outcomes in patients with renal dysfunction?

Population

499 patients with decreased renal function receiving LMWH

Comparison

Pre-emptive dosage reduction of LMWH and measured anti-Xa levels

Design

Single-center cohort study

Authors

PHPaul HornungWilhelmina Children's Hospital MKMeriem KhairounUniversity Medical Center Utrecht FDFriedo W. DekkerUniversity of Pisa

Discussion

Member takes

Implication

Pre-emptive LMWH dose reduction may yield subtherapeutic anti-Xa levels without altering bleeding, thrombosis or mortality risk; leaves open need for RCTs on monitoring in renal impairment.

Structured PICO

Does pre-emptive dosage reduction of LMWH lead to adequate anti-Xa levels and affect clinical outcomes in patients with renal dysfunction?

Population

499 adult patients (≥18 years) with decreased renal function (eGFR <60 ml/min/1.73m2) admitted to the Department of Internal Medicine, median age 68, 39% female. Key inclusion: therapeutic dosage of dalteparin or nadroparin.

Intervention

Pre-emptive dosage reduction of low molecular weight heparin (dalteparin or nadroparin) based on renal function (25% reduction for eGFR 30-60 ml/min/1.73m2 and 50% reduction for eGFR <30 ml/min/1.73m2).

Comparator

Patients receiving LMWH dosage according to guideline recommendations compared with those receiving dosages below or above guideline recommendations.

Outcome

Proportion of patients with anti-Xa levels falling within the reference target range (measured 4 hours after LMWH administration on the third day of use).surrogate

Pre-emptive dosage reduction of LMWH in patients with renal dysfunction frequently results in subtherapeutic anti-Xa levels, though this was not significantly associated with adverse clinical outcomes.

Cite This Study

Hornung et al. (2020) studied this question.

synapsesocial.com/papers/6a7379843800ec2ea6a72ac9 https://doi.org/10.1371/journal.pone.0239222

View Full Paper

Ask AI

Bookmark

Implication

Pre-emptive LMWH dose reduction may yield subtherapeutic anti-Xa levels without altering bleeding, thrombosis or mortality risk; leaves open need for RCTs on monitoring in renal impairment.

Dosage reduction of low weight heparin in patients with renal dysfunction: Effects on anti-Xa levels and clinical outcomes

Discussion

Member takes

Implication

Structured PICO

Cite This Study

Dosage reduction of low weight heparin in patients with renal dysfunction: Effects on anti-Xa levels and clinical outcomes

Discussion

Member takes

Implication

Structured PICO

Cite This Study

Also Consider

Also Consider