Correlation of Treatment Dose Enoxaparin with Anti-Xa Concentrations in Adult Hemodialysis Inpatients

Enoxaparin, a low-molecular-weight-heparin, is being used in hemodialysis patients despite a lack of guideline or manufacturer dose recommendations. Due to enoxaparin's renal excretion, the possibility of accumulating anti-Xa concentrations in hemodialysis patients using enoxaparin creates a hemorrhagic risk, calling for more research. The objectives of this study are to determine the correlation between treatment dose enoxaparin use and anti-Xa concentrations within the defined therapeutic range in patients receiving chronic, scheduled hemodialysis to determine the degree of change in anti-Xa concentrations in those cases where a concentration was obtained before and after a specific hemodialysis session, and to determine if there is evidence of enoxaparin accumulation over the course of treatment. This was a retrospective cohort study. Patients that were admitted to Indiana University Health facilities in a two-year period were identified from a Cerner query for inclusion eligibility. Inclusion criteria involved patients that received therapeutic dose enoxaparin based on actual body weight on a once daily basis, maintained a scheduled hemodialysis regimen, and had an anti-Xa concentration obtained after at least one enoxaparin dose. Despite lacking statistical significance, the data collected from this study depicts trends which can be utilized to guide future studies. The results of this study suggest that hemodialysis does not effectively remove enoxaparin.