Dekker Katharine R, Myers Brooke L, Barras Michael A
*Pharmacy Australia Centre of Excellence, School of Pharmacy, University of Queensland; and†Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, Australia.
Ther Drug Monit. 2016 Feb;38(1):59-63. doi: 10.1097/FTD.0000000000000233.
To investigate the compliance of prescribers with the state-wide Queensland Health (QH) guidelines for dosing and monitoring of enoxaparin, and to examine the effect that compliance has on the patients' length of stay (LOS) in hospital.
A 4-week retrospective study of consecutive inpatients who were administered enoxaparin for the treatment of an embolic disease. Data collected included influential patient demographics such as weight, renal function; details of antifactor Xa (aXa) monitoring, and patient LOS. All dosing and monitoring for each patient was compared to the current QH guidelines for enoxaparin usage; a multidisciplinary consensus document. The reasons for noncompliance were quantified and explored.
A total of 67 inpatients were recruited. The median (range) age, weight, and creatinine clearance of patients were 66 years (18-92), 78.5 kg (47.6-182), and 64 mL/min (16-180), respectively. Only 20 (30%) patients received enoxaparin in compliance with QH guidelines, leaving 47 (70%) noncompliant. The median (range) LOS was 7 (2-58) days for the compliant group versus 15 days (2-101) for the noncompliant (P = 0.06, Mann-Whitney U test). A total of 10 (15%) patients were monitored for aXa; none of whom were monitored correctly. Twenty-eight patients did not receive monitoring when indicated (moderate or severe renal impairment, weight >105 kg, or extended duration of therapy). In these patients, the median (range) LOS was 16.5 days (2-101).
Current prescribing of enoxaparin does not match state guidelines. Although not significant, there was a trend toward noncompliant patients having a greater LOS in hospital. The quality of aXa monitoring is suboptimal and barriers need to be explored. Larger studies are warranted.
调查处方医生对昆士兰卫生部门（QH）制定的全州范围内依诺肝素给药及监测指南的遵循情况，并研究遵循该指南对患者住院时间（LOS）的影响。
对连续接受依诺肝素治疗栓塞性疾病的住院患者进行为期4周的回顾性研究。收集的数据包括有影响的患者人口统计学资料，如体重、肾功能；抗Xa因子（aXa）监测的详细情况以及患者的住院时间。将每位患者的所有给药及监测情况与当前QH依诺肝素使用指南（一份多学科共识文件）进行比较。对不遵循指南的原因进行量化和探究。
共招募了67名住院患者。患者的年龄中位数（范围）为66岁（18 - 92岁），体重为78.5千克（47.6 - 182千克），肌酐清除率为64毫升/分钟（16 - 180）。只有20名（30%）患者按照QH指南接受依诺肝素治疗，其余47名（70%）未遵循指南。遵循指南组的住院时间中位数（范围）为7天（2 - 58天），未遵循指南组为15天（2 - 101天）（曼-惠特尼U检验，P = 0.06）。共有10名（15%）患者接受了aXa监测，但均未得到正确监测。28名患者在有指征时（中度或重度肾功能损害、体重>105千克或治疗时间延长）未接受监测。在这些患者中，住院时间中位数（范围）为16.5天（2 - 101天）。
目前依诺肝素的处方情况与州指南不符。尽管差异不显著，但未遵循指南的患者住院时间有延长的趋势。aXa监测质量欠佳，需要探究其中的障碍。有必要开展更大规模的研究。
