Prophylactic Enoxaparin in Critically Ill Patients with Severe Renal Insufficiency
CCCF ePoster library. Castellucci L. Oct 26, 2015; 114763; P84 Disclosure(s): The Ottawa Hospital Department of Medicine
Dr. Lana A. Castellucci
Dr. Lana A. Castellucci
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Abstract
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P84


Topic: Retrospective or Prospective Cohort Study


Prophylactic Enoxaparin in Critically Ill Patients with Severe Renal Insufficiency



Lana Castellucci, J. Shaw, S. Acres, R. Porteus, B. Gomes, C. Edwards, A. Giulivi, I. Watpool, M. Carrier, R. Patel

Department of Medicine, The Ottawa Hospital; Ottawa Hospital Research Institute; University of Ottawa, Ottawa, Canada | Department of Medicine, The Ottawa Hospital, Ottawa, Canada | Critical Care, Ottawa Hospital Research Institute, Ottawa, Canada | Critical Care, Ottawa Hospital Research Institute, Ottawa, Canada | Critical Care, The Ottawa Hospital, Ottawa, Canada | Medicine, The Ottawa Hospital, Ottawa, Canada | Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, Canada | Critical Care, The Ottawa Hospital, Ottawa, Canada | Medicine, The Ottawa Hospital; Ottawa Hospital Research Institute; University of Ottawa, Ottawa, Canada | Critical Care, The Ottawa Hospital, Ottawa, Canada

Introduction: Critically ill patients are at risk of both venous thrombosis and severe renal insufficiency. In patients with severe renal insufficiency, enoxaparin 30 mg daily is the recommended thromboprophylaxis dosing regimen to avoid potential bio-accumulation. To date, no study has evaluated the safety of using enoxaparin 30 mg daily in critically ill patients with severe renal insufficiency.

Objectives: To determine whether the use of enoxaparin prophylaxis at 30 mg daily in critically ill patients with severe renal insufficiency (creatinine clearance (CrCl) ≤ 30 ml/min, determined using the Cockcroft-Gault formula) is associated with clinically significant bio-accumulation.

Methods: In this prospective single-center cohort pilot study, we included patients > 18 years expected to be admitted to intensive care (ICU) for ≥ 72 hours with a CrCl of ≤ 30 ml/min. The primary outcome was bio-accumulation of enoxaparin defined as a trough anti-Xa level above 0.40 IU/ml. Trough anti-Xa levels were measured on days 1-4, 7, and 10. Secondary outcome measures included major bleeding episodes and venous thromboembolic events.

Results:

Thirty patients with median age of 62.5 years (range 25-86) and median APACHE II score of 32 (range 17-46) were enrolled. The median CrCl was 23.5 ml/min (range 8-30 ml/min) at enrolment. Six patients were dialysis dependent at baseline. Twenty-one patients received dialysis during ICU stay. Trough anti-Xa levels were measured on 132 occasions. No bioaccumulation of enoxaparin was detected and 85% of anti-Xa levels were undetectable (< 0.10 IU/ml). There were no spontaneous bleeding events. One patient received blood transfusion on study day 10 for progressive anaemia associated with rectal bleeding and bleeding at dialysis catheter site; the trough anti-Xa level was 0.26 IU/ml. There were no thrombotic events.



Conclusion: Our study suggests that a thromboprophylactic dose of enoxaparin 30 mg daily in critically ill patients with severe renal insufficiency does not seem to bio-accumulate. The clinical efficacy and safety profile remains to be assessed.

References: none
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