School of Pharmacy, Pharmacy Practice Department, Lebanese American University, P.O. Box 36, Mail Box: F 74, Byblos, Lebanon.
Int J Clin Pharm. 2011 Dec;33(6):934-41. doi: 10.1007/s11096-011-9559-1. Epub 2011 Sep 10.
Although, guidelines for the appropriate use of enoxaparin are published, yet the extent of their implementation in clinical practice is still questionable. Furthermore, the optimal dosing of enoxaparin in special populations such as renal insufficiency and obesity remains controversial. In the Middle East, there are insufficient data on the appropriateness of enoxaparin use in different indications.
(1) To assess the appropriateness of enoxaparin dosing and duration per indication in compliance with the recommended guidelines and their impact on safety and efficacy outcomes in Lebanese health care centers. (2) To evaluate the influence of the hospital type (teaching vs. non-teaching) on the extent of compliance with established guidelines.
Seventeen health care centers in Lebanon, including teaching and non-teaching hospitals.
An observational, cross-sectional, multicenter study was conducted in 17 Lebanese hospitals. Data on demographics, indication, dosing regimen and clinical outcomes were collected. The appropriateness of dosing practices was determined as per the ACCP guidelines and the FDA dosing recommendations.
The appropriateness of enoxaparin dosing was compared across different hospital type and among special populations including severe renal insufficiency and very obese patients.
Of the 463 patients who participated in the study, 40% received improper enoxaparin dosing, which was mostly observed in the VTE prophylaxis group (41.6%, P < 0.001). When comparing the overall dosing practices in Lebanese hospitals, there was no statistically significant difference in the correctness of enoxaparin dosing between teaching and non-teaching hospitals (61.6% vs. 58.2%, P = 0.449), respectively. Only 11.5% of renally impaired patients and 59.4% of obese patients received correct doses.
This study highlighted the improper practice and thus the need of implementation of clinical practice guidelines for the dosing of enoxaparin, in Lebanese hospitals.
尽管已经发布了关于依诺肝素合理使用的指南，但它们在临床实践中的实施程度仍存在疑问。此外，在肾功能不全和肥胖等特殊人群中，依诺肝素的最佳剂量仍存在争议。在中东地区，关于依诺肝素在不同适应证中的使用合理性的数据不足。
（1）评估黎巴嫩医疗机构中依诺肝素的剂量和用药时间是否符合推荐的指南，以及其对安全性和疗效结果的影响。（2）评估医院类型（教学医院与非教学医院）对指南遵循程度的影响。
黎巴嫩的 17 家医疗保健中心，包括教学医院和非教学医院。
在黎巴嫩的 17 家医院进行了一项观察性、横断面、多中心研究。收集了人口统计学、适应证、剂量方案和临床结局等数据。根据美国胸科医师学会（ACCP）指南和美国食品药品监督管理局（FDA）的剂量建议，确定了剂量方案的合理性。
比较不同医院类型和特殊人群（包括严重肾功能不全和非常肥胖的患者）之间依诺肝素剂量的合理性。
在参与研究的 463 名患者中，有 40%接受了不合理的依诺肝素剂量，这主要发生在静脉血栓栓塞症（VTE）预防组（41.6%，P < 0.001）。在比较黎巴嫩医院的整体剂量方案时，教学医院和非教学医院在依诺肝素剂量的正确性方面没有统计学上的显著差异（61.6%比 58.2%，P = 0.449）。只有 11.5%的肾功能不全患者和 59.4%的肥胖患者接受了正确的剂量。
这项研究强调了在黎巴嫩医院实施依诺肝素剂量的临床实践指南的必要性，以纠正不合理的用药实践。
