Factor Xa Levels in Patients Receiving Prophylactic Enoxaparin Sodium in the Intensive Care Unit of an Academic Hospital
Mayank M Baloo, Juan Scribante, Helen Perrie, Daren Calleemalay, Shahed Omar
Anesthesia, Enoxaparin, Intensive care unit, Pharmacokinetics–pharmacodynamics, Prevention of VTE, Venous thromboembolism, Venous thromboembolism (VTE) prophylaxis
Citation Information :
Baloo MM, Scribante J, Perrie H, Calleemalay D, Omar S. Factor Xa Levels in Patients Receiving Prophylactic Enoxaparin Sodium in the Intensive Care Unit of an Academic Hospital. Indian J Crit Care Med 2021; 25 (8):917-919.
Background: The aim of this study was to determine the anti-factor Xa levels in patients receiving enoxaparin sodium for venous thromboembolism prophylaxis in the intensive care unit (ICU).
Patients and methods: Using a cross-sectional study methodology, 73 ICU patients receiving 40 mg enoxaparin sodium daily were enrolled in this study. Anti-factor Xa levels were measured following the second dose. Prophylactic and subprophylactic groups of patients were compared for age, sex, weight, body mass index, total bilirubin, serum albumin, and APACHE II score.
Results: Anti-factor Xa levels were prophylactic (0.2–0.6 IU/mL) in 44 (60.3%) patients and subprophylactic (<0.2 IU/mL) in 29 (39.7%) patients. The mean (SD) actual delivered dose of enoxaparin per kilogram body weight was significantly higher, at 0.59 (0.11) mg/kg in the prophylactic group compared to 0.53 (0.13) mg/kg in the subprophylactic group (p = 0.043). The subprophylactic group had significantly lower serum albumin levels compared to the prophylactic group. The total bilirubin levels were not found to be significantly different between the two groups (p = 0.110).
Conclusion: A fixed prophylactic 40 mg dose of enoxaparin was associated with a high proportion of subprophylactic anti-factor Xa levels. Weight-based dose and serum albumin level were independent predictors of achieving the prophylactic target range.
Kopelman TR, Walters JW, Bogert JN, Basharat U, Pieri PG, Davis KM, et al. Goal directed enoxaparin dosing provides superior chemoprophylaxis against deep vein thrombosis. Injury 2017;48(5):1088–1092. DOI: 10.1016/j.injury.2016.10.039.
Wei MY, Ward SM. The anti-factor Xa range for low molecular weight heparin thromboprophylaxis. Hematol Rep 2015;7(4):80–83. DOI: 10.4081/hr.2015.5844.
Pannucci, CJ, Prazak, AM, Scheefer M. Utility of anti-factor Xa monitoring in surgical patients receiving prophylactic doses of enoxaparin for venous thromboembolism prophylaxis. Am J Surg 2017;213(6):1143–1152. DOI: 10.1016/j.amjsurg.2016.08.010.
Assareh H, Chen J, Ou L, Hollis SJ, Hillman K, Flabouris A. Rate of venous thromboembolism among surgical patients in Australian hospitals: a multicentre retrospective cohort study. BMJ Open 2014;4(10):e005502. DOI: 10.1136/bmjopen-2014-005502.
Heit JA, Spencer FA, White RH. The epidemiology of venous thromboembolism. J Thromb Thrombolysis 2016;41(1):3–14. DOI: 10.1007/s11239-015-1311-6.
Heit JA. Low-molecular-weight heparin: biochemistry, pharmacology, and concurrent drug precautions. Reg Anesth Pain Med 1998;23(6):135–139. DOI: 10.1016/s1098-7339(98)90138-9.
Hemker HC, Al Dieri R, Beguin S. Laboratory monitoring of low molecular weight heparin therapy part II. J Thromb Haemost 2005;3(3):571–573. DOI: 10.1111/j.1538-7836.2005.01206.x.
Linkins LA, Julian JA, Rischke J, Hirsh J, Weitz JI. In vitro comparison of the effect of heparin, enoxaparin and fondaparinux on tests of coagulation. Thromb Res 2002;107(5):241–244. DOI: 10.1016/S0049-3848(02)00340-7.
Wall V, Fleming KI, Tonna JE, Nunez J, Lonardo N, Shipley RW, et al. Anti-factor Xa measurements in acute care surgery patients to examine enoxaparin dose. Am J Surg 2018;216(2):222–229. DOI: 10.1016/j.amjsurg.2017.07.014.
Minville V, Asehnoune K, Ruiz S, Breden A, Georges B, Seguin T, et al. Increased creatinine clearance in polytrauma patients with normal serum creatinine: a retrospective observational study. Crit Care 2011;15(1):R49. DOI: 10.1186/cc10013.
Mayr AJ, Dünser M, Jochberger S, Fries D, Klingler A, Joannidis M, et al. Antifactor Xa activity in intensive care patients receiving thromboembolic prophylaxis with standard doses of enoxaparin. Thromb Res 2002;105(3):201–204. DOI: 10.1016/S0049-3848(02)00028-2.
Celik F, Huitema ADR, Hooijberg JH, van de Laar AW, Brandjes DP, Gerdes VE. Fixed-dose enoxaparin after bariatric surgery: the influence of body weight on peak anti-Xa levels. Obes Surg 2015;25(4):628–634. DOI: 10.1007/s11695-014-1435-3.
Freeman A, Horner T, Pendleton RC, Rondina, MT. Prospective comparison of three enoxaparin dosing regimens to achieve target anti-factor Xa levels in hospitalized, medically ill patients with extreme obesity. Am J Hematol 2012;87(7):740–743. DOI: 10.1002/ajh.23228.
Wagner JG. Simple model to explain effects of plasma protein binding and tissue binding on calculated volumes of distribution, apparent elimination rate constants and clearances. Eur J Clin Pharmacol 1976;10(6):425–432. DOI: 10.1007/BF0056307.
Chi G, Gibson CM, Liu Y, Hernandez AF, Hull RD, Cohen AT, et al. Inverse relationship of serum albumin to the risk of venous thromboembolism among acutely ill hospitalized patients: analysis from the APEX trial. Am J Hematol 2019;94(1):21–28. DOI: 10.1002/ajh.25296.