Abstract
Background
The safety and optimal use of prophylactic treatment with low-molecular-weight heparins in elderly patients with impaired renal function remain undefined.
Methods
The primary aim of this study was to analyse, in ‘real life’, the influence of renal function, as assessed by Creatinine clearance (CLcr), on the level of anti-Xa activity in medical hospitalised elderly patients receiving prophylactic dosages of enoxaparin. Consecutive hospitalised acutely ill medical patients aged ≥75 years receiving daily dosages of enoxaparin 4000IU for up to 10 days were prospectively enrolled in two centres. Peak anti-Xa activity was measured at the beginning and during the course of therapy.
Results
One hundred and twenty-five patients (31 men, 94 women), mean age 87.5 ± 6.3 years, mean bodyweight 56.4±11.9kg and mean CLcr 39.8 ± 16.1 mL/min, were enrolled in the study. The mean maximum anti-Xa activity (day 1 to day 10) [anti-Xamaxl–l0] was 0.64 ± 0.23 IU/mL (range 0.24–1.50 IU/mL). Weak negative correlations were found between CLcr and anti-Xamax and between bodyweight and anti-Xamax. Mean anti-Xamax was slightly but significantly higher in patients with CLcr of 20–30 mL/min compared with patients with CLcr of 31–40,41–50 or 51–80 mL/min (0.72 versus 0.61, 0.61 and 0.60 IU/ mL, respectively), and in patients weighing <50kg compared with patients weighing 50–60kg or >60kg (0.74 vs 0.64 and 0.52 IU/mL, respectively). Serious bleeding occurred in five patients, but anti-Xamax values in these patients were not different to those in patients without bleeding (p = 0.77). Individual anti-Xamax at the beginning or during the course of treatment was measured in the subgroup of 58 patients in whom anti-Xa activity was measured at least once during the study. The mean anti-Xamax value was slightly but significantly higher during the course of the therapy than at the beginning of the study (0.63 ± 0.26 IU/mL vs 0.56±0.23 IU/mL, p = 0.012).
Conclusion
Only CLcr <30 mL/min and bodyweight <50kg were associated with significantly higher anti-Xamax values. The clinical relevance of these increases remains questionable. No conclusions about the safety of enoxaparin in elderly medical patients can be drawn from these findings.
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Acknowledgements
No sources of funding were used to assist in the preparation of this study. Dr Bergmann has been a member of steering committees for Aventis and has participated in the conduct of therapeutic trials by Aventis and AstraZeneca. Dr Drouet has received honoraria from sanofi-aventis, Bristol Myers-Squibb, GlaxoSmithKline and AstraZeneca; has acted as a consultant for Hoffmann la Roche; has received grants from sanofi-aventis; and has grants pending from GlaxoSmithKline. The authors have no other potential conflicts of interest of direct relevance to the content of this study.
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Mahe, I., Gouin-Thibault, I., Drouet, L. et al. Elderly Medical Patients Treated with Prophylactic Dosages of Enoxaparin. Drugs Aging 24, 63–71 (2007). https://doi.org/10.2165/00002512-200724010-00005
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DOI: https://doi.org/10.2165/00002512-200724010-00005