Development of a dosage strategy in patients receiving enoxaparin by continuous intravenous infusion using modelling and simulation
| Autor: | Sandra L. Kane-Gill, Bruce Green, Robert R. Bies, Stephen B. Duffull, Mary Beth Bobek, Yan Feng |
|---|---|
| Rok vydání: | 2006 |
| Předmět: |
Adult
Male Adolescent Critical Care Metabolic Clearance Rate Renal function Kidney Drug Administration Schedule law.invention chemistry.chemical_compound Pharmacokinetics law Intensive care Thromboembolism Medicine Humans Pharmacology (medical) Dosing Enoxaparin Infusions Intravenous Aged Retrospective Studies Pharmacology Volume of distribution Aged 80 and over Venous Thrombosis Creatinine business.industry Body Weight Anticoagulants Middle Aged Intensive care unit NONMEM chemistry Pharmacodynamics Anesthesia Linear Models Female business |
| Zdroj: | British journal of clinical pharmacology. 62(2) |
| ISSN: | 0306-5251 |
| Popis: | To develop an appropriate dosing strategy for continuous intravenous infusions (CII) of enoxaparin by minimizing the percentage of steady-state anti-Xa concentration (C(ss)) outside the therapeutic range of 0.5-1.2 IU ml(-1).A nonlinear mixed effects model was developed with NONMEM for 48 adult patients who received CII of enoxaparin with infusion durations that ranged from 8 to 894 h at rates between 100 and 1600 IU h(-1). Three hundred and sixty-three anti-Xa concentration measurements were available from patients who received CII. These were combined with 309 anti-Xa concentrations from 35 patients who received subcutaneous enoxaparin. The effects of age, body size, height, sex, creatinine clearance (CrCL) and patient location [intensive care unit (ICU) or general medical unit] on pharmacokinetic (PK) parameters were evaluated. Monte Carlo simulations were used to (i) evaluate covariate effects on C(ss) and (ii) compare the impact of different infusion rates on predicted C(ss). The best dose was selected based on the highest probability that the C(ss) achieved would lie within the therapeutic range.A two-compartment linear model with additive and proportional residual error for general medical unit patients and only a proportional error for patients in ICU provided the best description of the data. Both CrCL and weight were found to affect significantly clearance and volume of distribution of the central compartment, respectively. Simulations suggested that the best doses for patients in the ICU setting were 50 IU kg(-1) per 12 h (4.2 IU kg(-1) h(-1)) if CrCL30 ml min(-1); 60 IU kg(-1) per 12 h (5.0 IU kg(-1) h(-1)) if CrCL was 30-50 ml min(-1); and 70 IU kg(-1) per 12 h (5.8 IU kg(-1) h(-1)) if CrCL50 ml min(-1). The best doses for patients in the general medical unit were 60 IU kg(-1) per 12 h (5.0 IU kg(-1) h(-1)) if CrCL30 ml min(-1); 70 IU kg(-1) per 12 h (5.8 IU kg(-1) h(-1)) if CrCL was 30-50 ml min(-1); and 100 IU kg(-1) per 12 h (8.3 IU kg(-1) h(-1)) if CrCL50 ml min(-1). These best doses were selected based on providing the lowest equal probability of either being above or below the therapeutic range and the highest probability that the C(ss) achieved would lie within the therapeutic range.The dose of enoxaparin should be individualized to the patients' renal function and weight. There is some evidence to support slightly lower doses of CII enoxaparin in patients in the ICU setting. |
| Databáze: | OpenAIRE |
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