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Current dosing of low‐molecular‐weight heparins does not reflect licensed product labels: an international survey
Author(s) -
Barras Michael A.,
Kirkpatrick Carl M. J.,
Green Bruce
Publication year - 2010
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/j.1365-2125.2010.03626.x
Subject(s) - dosing , medicine , renal function , low molecular weight heparin , body weight , intensive care medicine , emergency medicine , heparin
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Low‐molecular‐weight heparins (LMWHs) are effective anti‐coagulants for the treatment of thromboembolic diseases. • LMWHs are hydrophilic drugs with clearance related to lean body weight and renal function. • Poor subject outcomes are linked to the inadequate dosing of LMWHs. WHAT THIS STUDY ADDS • Minimal adherence to the product label occured when dosing LMWHs. • Hospitals preferred to dose‐individualize using a variety of methods that included dose‐capping, post‐dose monitoring of anti‐Xa activity and the use of lean body size descriptors to calculate a starting dose and renal function. AIMS Low‐molecular‐weight heparins (LMWHs) are used globally to treat thromboembolic diseases; however, there is much debate on how to prescribe effectively for patients who have renal impairment and/or obesity. We aimed to investigate the strategies used to dose‐individualize LMWH therapy. METHODS We conducted an online survey of selected hospitals in Australia, New Zealand (NZ), United Kingdom (UK) and the United States (US). Outcome measures included: the percentage of hospitals which recommended that LMWHs were prescribed according to the product label (PL), the percentage of hospitals that dose‐individualized LMWHs outside the PL based on renal function, body weight and anti‐Xa activity and a summary of methods used to dose‐individualize therapy. RESULTS A total of 257 surveys were suitable for analysis: 84 (33%) from Australia, 79 (31%) from the UK, 73 (28%) from the US and 21 (8%) from NZ. Formal dosing protocols were used in 207 (81%) hospitals, of which 198 (96%) did not adhere to the PL. Of these 198 hospitals, 175 (87%) preferred to dose‐individualize based on renal function, 128 (62%) on body weight and 48 (23%) by monitoring anti‐Xa activity. All three of these variables were used in 29 (14%) hospitals, 98 (47%) used two variables and 71 (34%) used only one variable. CONCLUSIONS Dose‐individualization strategies for LMWHs, which contravene the PL, were present in 96% of surveyed hospitals. Common individualization methods included dose‐capping, use of lean body size descriptors to calculate renal function and the starting dose, followed by post dose anti‐Xa monitoring.