Enoxaparin Use and Adverse Events in Outpatients With a Continuous Flow Left Ventricular Assist Device at a Single Institution
| Autor: | Laura C Czerniak, Kathleen E. Horner, Alexandros Briasoulis, Heather R. Bream-Rouwenhorst, Allison M Bernard, Paulino Alvarez |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adolescent
medicine.medical_treatment Hemorrhage 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Outpatients medicine Humans Pharmacology (medical) 030212 general & internal medicine Dosing Prospective Studies Single institution Enoxaparin Prospective cohort study Adverse effect Retrospective Studies business.industry Warfarin Anticoagulants Thrombosis Guideline Discontinuation Anesthesia Ventricular assist device Heart-Assist Devices business medicine.drug |
| Zdroj: | Journal of pharmacy practice. 35(3) |
| ISSN: | 1531-1937 |
| Popis: | Background: Patients with left ventricular assist devices (LVADs) are anticoagulated with warfarin and may receive enoxaparin bridging for a subtherapeutic international normalized ratio (INR). There is no guideline regarding enoxaparin bridging in LVAD patients and a dosing strategy to ensure efficacy and safety is uncertain. Objective: The objective was to characterize the use of enoxaparin bridging for subtherapeutic INRs and its impact on thrombotic or major bleeding events (MBE) in patients with an LVAD. Methods: A retrospective review from 6/1/17 to 6/30/18 was performed. Patients with an LVAD were excluded if they had less than 60 days of outpatient anticoagulation or age Results: Seventy-one LVAD patients met inclusion criteria and 50 patients received enoxaparin bridging. Therapeutic-dose enoxaparin was initiated at a mean INR of 1.8 for a mean duration of 2.8 days. In the enoxaparin exposure group, one MBE occurred 6 days after enoxaparin discontinuation, coinciding with an INR increase from 1.8 to 4.7. One thrombotic event occurred 2 days after enoxaparin discontinuation at an INR of 5.0. Conclusion: This institution’s bridging strategy of therapeutic-dose enoxaparin with a short duration has a low rate of bleeding and thrombotic events. Additional prospective studies of anticoagulation bridging based on characteristics such as type of LVAD device are warranted. |
| Databáze: | OpenAIRE |
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