Ma Jessica M, Jackevicius Cynthia A, Yeo Erik
Department of Pharmaceutical Services, Toronto East General Hospital, Toronto, Ontario, Canada.
Ann Pharmacother. 2004 Oct;38(10):1576-81. doi: 10.1345/aph.1E096. Epub 2004 Aug 24.
There are limited data on dosing of enoxaparin in patients with renal disease due to the routine exclusion of this population in clinical trials. To account for the potentially delayed drug elimination in these patients, we developed guidelines for adjusting enoxaparin dosing based on anti-Xa monitoring.
To evaluate anti-Xa level monitoring, resulting from the standards of practice as set out by our hospital's guidelines for enoxaparin dosing in renally impaired patients.
A total of 72 separate acute coronary syndrome patient admissions were retrospectively reviewed. All patients had anti-Xa levels taken and creatinine clearance values <30 mL/min during enoxaparin therapy.
The average trough anti-Xa level at the once- and twice-daily doses was 0.40 and 0.72 IU/mL, respectively. With twice-daily dosing, only 6% of the trough concentrations were in the target range of 0.2-0.3 IU/mL compared with 36% with once-daily dosing. Of the 22 patients who had a change of dosing frequency from twice to once daily, 5% of trough anti-Xa levels were </=0.5 IU/mL with twice-daily versus 68% with once-daily dosing.
Although the relationship between anti-Xa activity, efficacy, and adverse effects has not been definitively established, anti-Xa levels can assist with dosing of enoxaparin in renally impaired patients. Our hospital guidelines are effective in adjusting dosing to reach target anti-Xa levels.
由于临床试验中常规排除肾病患者群体，关于依诺肝素在肾病患者中的给药数据有限。为了考虑这些患者中可能延迟的药物消除情况，我们制定了基于抗Xa监测来调整依诺肝素剂量的指南。
评估我院针对肾功能受损患者依诺肝素给药指南所规定的实践标准所产生的抗Xa水平监测情况。
回顾性审查了72例单独的急性冠状动脉综合征患者入院病例。所有患者在接受依诺肝素治疗期间均检测了抗Xa水平且肌酐清除率值<30 mL/min。
每日一次和每日两次给药时的平均谷值抗Xa水平分别为0.40和0.72 IU/mL。每日两次给药时，只有6%的谷浓度处于0.2 - 0.3 IU/mL的目标范围内，而每日一次给药时为36%。在22例从每日两次改为每日一次给药频率的患者中，每日两次给药时5%的谷值抗Xa水平≤0.5 IU/mL，而每日一次给药时为68%。
尽管抗Xa活性、疗效和不良反应之间的关系尚未明确确立，但抗Xa水平可有助于肾功能受损患者的依诺肝素给药。我院的指南在调整剂量以达到目标抗Xa水平方面是有效的。
