Key Points
- Investigate clinical strategies used across international hospitals to dose-individualize low-molecular-weight heparin (LMWH) therapy relative to licensed product labels.
- Conducted an online survey of selected hospitals across Australia, New Zealand, the United Kingdom, and the United States (N=257 analyzed).
- Evaluated the prevalence of formal LMWH dosing protocols, adherence to licensed product labels, and strategies used for individualization based on renal function, body weight, and anti-Xa activity monitoring.
- Formal dosing protocols were utilized in 207 of 257 hospitals (81%), of which 198 (96%) did not adhere to the licensed product label.
- Among the 198 non-adherent hospitals, dose individualization was guided by renal function in 175 (87%), body weight in 128 (62%), and post-dose anti-Xa monitoring in 48 (23%).
- Dose-individualization protocols incorporated all three clinical variables in 29 hospitals (14%), two variables in 98 (47%), and one variable in 71 (34%).
Structured PICO
PPopulation257 hospitals in Australia, New Zealand, UK, and US
IInterventionDose-individualization strategies for low-molecular-weight heparins (LMWHs)
CComparatorProduct label dosing
OOutcomePercentage of hospitals recommending LMWH prescription according to product label and percentage dose-individualizing outside the product label based on renal function, body weight, and anti-Xa activity
The vast majority of surveyed hospitals do not adhere to product labels for LMWH dosing, instead preferring various dose-individualization strategies based on renal function, body weight, and anti-Xa monitoring.