Assessment of an Extended Interval Fondaparinux Dosing Regimen for Venous Thromboembolism Prophylaxis in Critically Ill Patients with Severe Renal Dysfunction Using Antifactor Xa Levels
| Autor: | Lauren K. Riley, Steven D. Tennenberg, Krista Wahby |
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| Rok vydání: | 2017 |
| Předmět: |
Male
Critical Illness medicine.medical_treatment Deep vein Renal function 030204 cardiovascular system & hematology Fondaparinux Severity of Illness Index Drug Administration Schedule law.invention 03 medical and health sciences 0302 clinical medicine Polysaccharides law Humans Medicine Pharmacology (medical) Prospective Studies 030212 general & internal medicine Dosing Renal replacement therapy Venous Thrombosis business.industry Acute kidney injury Acute Kidney Injury Middle Aged medicine.disease Intensive care unit Regimen medicine.anatomical_structure Anesthesia Factor Xa Kidney Failure Chronic Female Drug Monitoring business Factor Xa Inhibitors medicine.drug |
| Zdroj: | Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 37:1241-1248 |
| ISSN: | 0277-0008 |
| DOI: | 10.1002/phar.2014 |
| Popis: | Objective Pharmacologic options for venous thromboembolism (VTE) prophylaxis are often limited in critically ill patients due to thrombocytopenia and multisystem organ dysfunction. Fondaparinux offers potential advantages in the critically ill; however, it is currently contraindicated in severe renal dysfunction (SRD). We evaluated antifactor Xa levels in critically ill patients with SRD who were receiving an extended interval dosing regimen of fondaparinux for VTE prophylaxis. Methods A prospective, single arm, interventional study was conducted at two academic hospitals of the Detroit Medical Center. Eligible patients were in the intensive care unit, had an estimated creatinine clearance less than30 ml/min, and had either acute kidney injury or end-stage renal disease; several patients were on renal replacement therapy. Fondaparinux was administered at an extended interval dosing regimen of 2.5 mg subcutaneously every 48 hours. Fondaparinux peak and trough antifactor Xa levels were obtained. Lower extremity venous duplex studies were performed at baseline and study completion to assess for deep vein thrombosis (DVT), and patients were monitored for bleeding complications. Results Thirty two patients were enrolled. Patients received a median of 4 doses (interquartile range 2-5) of fondaparinux. Fondaparinux peak (n=98) and trough (n=86) antifactor Xa levels were 0.36 ± 0.18 mg/L and 0.17 ± 0.11 mg/L (mean ± SD), respectively, and were similar to levels reported in patients with normal renal function receiving conventional once-daily dosing. No lower extremity DVTs or suspected VTE events occurred. Two patients (6%) had significant bleeding events. Conclusions In critically ill patients with SRD, an extended interval fondaparinux dosing regimen of 2.5 mg every 48 hours for VTE prophylaxis achieved peak and trough antifactor Xa levels similar to those reported in noncritically ill patients with normal renal function receiving once-daily fondaparinux. This regimen offers an alternative for patients with SRD when heparinoids must be avoided. This article is protected by copyright. All rights reserved. |
| Databáze: | OpenAIRE |
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