Department of Hospital Pharmacy, Elisabeth TweeSteden Hospital, Tilburg, The Netherlands.
Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands.
Eur J Clin Pharmacol. 2022 Sep;78(9):1469-1479. doi: 10.1007/s00228-022-03344-9. Epub 2022 Jun 17.
International guidelines vary in their recommendations whether or not to reduce the therapeutic dose of low molecular weight heparins (LMWHs) in renal impairment. The use of anti-Xa monitoring as a basis of dose adjustments is also a matter of debate. As this may lead to variations in treatment policies, we aimed to study the treatment policies of therapeutically dosed LMWHs in renal impairment in Dutch hospitals.
An 11-item survey was distributed between June 2020 and March 2021 to hospital pharmacists, representing Dutch hospital organisations. Primary outcomes were the dosing regimens of therapeutically dosed LMWHs in renally impaired patients. Secondary outcomes were the proportion of hospitals that used anti-Xa monitoring and the anti-Xa target range used.
There was a response from 56 of 69 (81%) Dutch hospital organisations where in each case a hospital pharmacist completed the survey. In these hospitals, 77 LMWH regimens were in use. In 76 of 77 (99%) regimens, a regular dose reduction was used at the start of treatment. Fifty-five of these hospitals used a dose reduction if estimated glomerular filtration rate (eGFR) < 50 ml/min and 17 used a dose reduction if eGFR < 30 ml/min. Anti-Xa levels were not routinely monitored in 40% of regimens, while 22% monitored anti-Xa if eGFR < 50 ml/min, 27% if eGFR < 30 ml/min and 10% in other eGFR cutoff values. Target ranges of 1.0-2.0 IU/ml (once daily) and 0.5/0.6-1.0 IU/ml (twice daily) were used in 69% of regimens that included monitoring of anti-Xa.
Treatment policies show substantial diversity in therapeutically dosed LMWHs in renally impaired patients. The most commonly used treatment regimen was a regular dose reduction if eGFR is < 50 ml/min, without anti-Xa monitoring.
国际指南在建议是否减少低分子肝素（LMWH）在肾功能损害患者中的治疗剂量方面存在差异。抗 Xa 监测作为剂量调整的基础也是一个有争议的问题。由于这可能导致治疗政策的差异，我们旨在研究荷兰医院肾功能损害患者中治疗剂量 LMWH 的治疗政策。
在 2020 年 6 月至 2021 年 3 月期间，向代表荷兰医院组织的医院药剂师分发了一份 11 项内容的调查问卷。主要结局是肾功能损害患者中接受治疗剂量 LMWH 的给药方案。次要结局是使用抗 Xa 监测的医院比例和使用的抗 Xa 靶范围。
在 69 家荷兰医院组织中，有 56 家（81%）做出了回应，其中每家医院的药剂师都完成了调查。在这些医院中，有 77 种 LMWH 方案在使用。在 77 种方案中的 76 种（99%）中，在开始治疗时会常规进行剂量减少。如果估计肾小球滤过率（eGFR）<50 ml/min，55 家医院会进行剂量减少，如果 eGFR<30 ml/min，则有 17 家医院会进行剂量减少。40%的方案没有常规监测抗 Xa 水平，而如果 eGFR<50 ml/min，22%的方案监测抗 Xa，如果 eGFR<30 ml/min，27%的方案监测抗 Xa，如果其他 eGFR 截断值，则 10%的方案监测抗 Xa。在包括监测抗 Xa 的 69%的方案中，使用的靶范围为 1.0-2.0 IU/ml（每日一次）和 0.5/0.6-1.0 IU/ml（每日两次）。
治疗政策显示肾功能损害患者中治疗剂量 LMWH 的使用存在显著差异。最常用的治疗方案是如果 eGFR<50 ml/min，则进行常规剂量减少，而不进行抗 Xa 监测。
