Pharmacokinetic Comparison of Subcutaneous and Intravenous Nadroparin Administration for Thromboprophylaxis in Critically Ill Patients on Vasopressors
Language English Country Switzerland Media print-electronic
Document type Journal Article, Randomized Controlled Trial
PubMed
31578015
DOI
10.1159/000502847
PII: 000502847
Knihovny.cz E-resources
- Keywords
- Anti-factor Xa activity, Low molecular weight heparin, Pharmacokinetics, Prophylaxis, Thromboembolism, Vasopressors,
- MeSH
- Anticoagulants administration & dosage pharmacokinetics MeSH
- Factor Xa analysis MeSH
- Injections, Subcutaneous MeSH
- Administration, Intravenous MeSH
- Critical Illness MeSH
- Middle Aged MeSH
- Humans MeSH
- Nadroparin administration & dosage pharmacokinetics MeSH
- Aged MeSH
- Vasoconstrictor Agents therapeutic use MeSH
- Venous Thromboembolism prevention & control MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial MeSH
- Names of Substances
- Anticoagulants MeSH
- Factor Xa MeSH
- Nadroparin MeSH
- Vasoconstrictor Agents MeSH
INTRODUCTION: Critically ill patients are exposed to a high risk of developing thromboembolism. Moreover, standard prophylaxis with subcutaneous (SC) heparin is less efficient in patients requiring vasopressors. The aim is a comparison of pharmacokinetics between SC and intravenous (IV) applied nadroparin. METHODS: Thirty-eight ventilated ICU patients requiring vasopressor support were randomized into a single dose of nadroparin 3,800 IU (0.4 mL) subcutaneously (SC group) or 1,900 IU (0.2 mL) intravenously (IV group). Anti-factor Xa activity (anti-Xa) was observed over 24 h; data are stated as median (IQR). RESULTS: Peak anti-Xa was significantly higher in the IV group 0.42 (0.39-0.43) IU/mL than in the SC group 0.16 (0.09-0.18) IU/mL (p < 0.001). There was a trend towards higher area under the curve (AUC) of anti-Xa in the SC group 1.41 (0.41-1.80) IU/mL × h than in the IV group 1.04 (0.93-1.13) IU/mL × h (p = 0.08). In the SC group, there was a negative correlation between anti-Xa AUC and both capillary refill time Xa (r = -0.86) and norepinephrine dose (r = -0.68). In the IV group, anti-Xa decrease half-life was 1.6 (1.4-2.0) h. CONCLUSIONS: IV administration of 1,900 IU of nadroparin led to a predictable effective peak anti-Xa. After SC administration, anti-Xa was heterogeneous and significantly influenced by peripheral perfusion.
Department of Anesthesiology and Intensive Care Hospital Ceske Budejovice Ceske Budejovice Czechia
Department of Internal Medicine Hematology and Oncology University Hospital Brno Brno Czechia
References provided by Crossref.org
Update on Anticoagulation Strategies in Patients with ECMO-A Narrative Review