School of Pharmacy, University of Otago, Dunedin, New Zealand.
Clin Pharmacokinet. 2010 Sep;49(9):567-71. doi: 10.2165/11532960-000000000-00000.
Low-molecular-weight heparins are anticoagulants used in the treatment of thrombosis. They have effectiveness and safety profiles similar to those of unfractionated heparin but are considered an attractive alternative because of their predictable pharmacokinetic characteristics. In this article, we demonstrate the need for therapeutic monitoring of low-molecular-weight heparins by addressing evidence arising from the literature and from modelling and simulation. First, treatment targets for unfractionated heparin and enoxaparin sodium were identified. Then, 10 000 virtual patients were simulated and the rate of treatment success was calculated. Treatment success was found to be similar between the two drugs (48% with unfractionated heparin and 54% with enoxaparin sodium). These results are consistent with empirical evidence from the literature and reflect the inadequacy of current dosing strategies in achieving desired biomarker targets. These results, along with recent advances in Bayesian forecasting techniques, support the need for routine monitoring and dose individualization of enoxaparin sodium in order to improve treatment success.
低分子量肝素是一种用于治疗血栓的抗凝剂。它们的有效性和安全性与未分级肝素相似，但由于其可预测的药代动力学特征，被认为是一种有吸引力的替代药物。在本文中，我们通过文献证据以及建模和模拟来证明低分子量肝素需要进行治疗监测。首先，确定了未分级肝素和依诺肝素钠的治疗目标。然后，模拟了 10000 名虚拟患者，并计算了治疗成功率。发现两种药物的治疗成功率相似（未分级肝素为 48%，依诺肝素钠为 54%）。这些结果与文献中的经验证据一致，反映了目前的给药策略在达到理想生物标志物目标方面的不足。这些结果以及贝叶斯预测技术的最新进展，支持依诺肝素钠常规监测和剂量个体化的必要性，以提高治疗成功率。
