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Can we reliably predict the level of anticoagulation after enoxaparin injection in elderly patients with renal failure?

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Abstract

Objectives

The aim of this study was to evaluate the activity of anti-activated factor X (anti-Xa) in patients with different degrees of chronic renal failure (CRF), treated with therapeutic doses of low molecular weight heparin.

Design

This prospective study evaluated the effect of age, renal function, BMI, gender, in determining the efficacy and safety of treatment with enoxaparin, evaluated by assessing the anti-Xa. The therapeutic anticoagulant range was set between 0.20 and 0.70 U/mL.

Setting

Two hospital geriatric units.

Participants

98 patients (64 men, 34 women, mean age 82 years) with CRF, treated with enoxaparin at therapeutic dosage, for deep vein thrombosis or acute coronary syndrome.

Measurements

Anti-Xa was assessed 4 h after the third administration of LMWH using Chromogenix test. Renal function was assessed by calculating creatinine clearance according to Cockcroft formula.

Results

The dose of enoxaparin ranged between 53 and 200 U/kg; total 4000–16000 U/day. The mean anti-Xa was 0.41 U/mL (95% CI 0.36–0.45). Multiple regression analysis selected only the dose of enoxaparin, but not age, creatinine clearance, BMI, gender, as a predictor of anti-Xa serum levels. In seven patients anti-Xa was above the range but none of them received more than 150 U/Kg enoxaparin (100 U/kg if creatinine clearance <30 mL/min). Ten patients (eight men, two women) showed suboptimal levels of anti-Xa, regardless enoxaparin dose or creatinine clearance.

Conclusion

Enoxaparin dose reduction according to renal function decreases the risk of overdosing and potentially the risk of bleeding. The risk of under dosing seems less predictable; therefore, anti-Xa assay may be useful in severe clinical situations that require higher anticoagulant activity.

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Authors and Affiliations

  1. Geriatric Unit A, Azienda Ospedaliera Universitaria Integrata, Verona, Italy

    Luca Pellizzari, Luigi Corrà, Anna Sepe, Giorgia Fontana & Vincenzo Di Francesco

  2. Laboratory of Clinical Chemistry and Hematology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy

    Roberto Facchinetti

  3. Geriatric Unit, Department of Medicine, University of Verona, Verona, Italy

    Francesco Fantin & Mauro Zamboni

Authors
  1. Luca Pellizzari
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  2. Roberto Facchinetti
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  3. Luigi Corrà
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  4. Anna Sepe
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  5. Francesco Fantin
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  6. Giorgia Fontana
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  7. Mauro Zamboni
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  8. Vincenzo Di Francesco
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Corresponding author

Correspondence to Vincenzo Di Francesco.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Informed consent

A written informed consent was obtained in all the participants, study protocol was approved by our Institution Ethical Committee.

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Pellizzari, L., Facchinetti, R., Corrà, L. et al. Can we reliably predict the level of anticoagulation after enoxaparin injection in elderly patients with renal failure?. Aging Clin Exp Res 30, 605–608 (2018). https://doi.org/10.1007/s40520-017-0822-8

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  • DOI: https://doi.org/10.1007/s40520-017-0822-8

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