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Prophylactic anticoagulation with enoxaparin: Is the subcutaneous route appropriate in the critically ill?*

2003; Lippincott Williams & Wilkins; Volume: 31; Issue: 5 Linguagem: Inglês

10.1097/01.ccm.0000059725.60509.a0

1530-0293

Ute Priglinger, Georg Delle Karth, Alexander Geppert, Christian Joukhadar, S. Graf, Rudolf Berger, Martin Hülsmann, Susanne Spitzauer, Ingrid Pabinger, GH Heinz,

Acute Myocardial Infarction Research

Background Subcutaneously administered low-molecular-weight heparins are widely used for prevention of venous thromboembolism. The appropriateness of the subcutaneous route in critically ill patients has never been established. Objective To determine anti-Xa activities in critically ill patients and in noncritically ill patients receiving prophylactic doses of subcutaneous enoxaparin. Design Prospective, controlled, open-labeled study. Setting Tertiary medical-cardiologic-postoperative intensive care unit and a general medical ward at a university hospital. Patients A total of 16 intensive care unit patients (group 1; age, 61.1 ± 16 yrs; male/female ratio, 7/9; Acute Physiology and Chronic Health Evaluation II score, 20.9 ± 7; mechanical ventilation, n = 15; vasopressors, n = 13) and 13 noncritically ill medical patients (group 2; age, 61.7 ± 9 yrs; male/female ratio, 7/6) were studied. Body mass index (25.7 ± 5 vs. 24 ± 6 kg/m2, p = not significant) was comparable and serum creatinine levels (0.83 ± 0.25 vs. 1.07 ± 0.3 mg/dL, group 1 vs. 2) were within the normal range in both groups. Patients with impaired renal function, receiving hemofiltration, or requiring therapeutic anticoagulation were not eligible. Interventions None. Measurements and Main Results Anti-Xa activities were determined at 0, 1, 3, 6, and 12 hrs after a single daily subcutaneous dose of 40 mg enoxaparin on day 1 and at 3 hrs after 40 mg of enoxaparin on days 2–5. Mean anti-Xa levels at 0 to 12 hrs were consistently lower in group 1 compared with group 2 by analysis of variance (p = .001 between groups and over time), as was the area under the curve at 0 to 12 hrs (2.6 ± 1 vs. 4.2 ± 1.7 units·mL−1·hr−1, group 1 vs. 2, p = .008). Significant differences in anti-Xa activity were also found on days 2–5 (p = .001). Peak anti-Xa activities at 3 hrs after administration were negatively correlated with the body mass index (r = −.41, p < .03). No correlation was found between the anti-Xa activity at 3 hrs and the dose of norepinephrine (r = .12, p = .7). Conclusion Critically ill patients with normal renal function demonstrated significantly lower anti-Xa levels in response to a single daily dose of subcutaneous enoxaparin when compared with medical patients in the normal ward.