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Prophylactic anticoagulation with low dose enoxaparin: is the subcutaneous route appropriate in the critically ill?
Critical Care volume 6, Article number: P126 (2002)
Subcutaneously administered LMW heparins are widely used for prophylactic anticoagulation. The appropriateness of the SC route in critically ill patients who require vasopressors and mechanical ventilation has never been established.
The anti-Xa kinetic (0, 1, 3, 6, 12 hours) following 40 mg of enoxaparin SC was investigated in 16 ICU patients (group 1; age 61.1 ± 16 years; m/f 7/9, APACHE II 20.9 ± 7, mechanical ventilation n = 15, vasopressors n = 13) and 13 non critically ill patients on the general ward (group 2; age 61.7 ± 9 years, m/f 7/6) requiring prophylactic anticoagulation. Patients with impaired renal function or requiring hemofiltration and those requiring therapeutic anticoagulation were not eligible.
Mean anti-Xa levels were consistently lower in group 1 vs group 2 on ANOVA (P = 0.001 between groups and over time) as was the AUC0–12 hours (2.6 ± 1 vs 4.2 ± 1.7 U/ml*h, group 1 vs 2, P = 0.008). BMI (25.7 ± 5 vs 24 ± 6 kg/m2) and creatinine clearance (67.5 ± 31 vs 67.7 ± 27 mg/dl) were comparable in both groups (P = ns). The peak anti-Xa level 3 hours after administration was negatively correlated to the BMI (r = -0.41, P < 0.03) and the norepinephrine dose (r = -0.36, P = 0.056).
It is cautiously concluded that the SC administration of established doses of prophylactic enoxaparin might not be appropriate in the critically ill patient requiring vasopressor support and mechanical ventilation.
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Priglinger, U., Delle Karth, G., Geppert, A. et al. Prophylactic anticoagulation with low dose enoxaparin: is the subcutaneous route appropriate in the critically ill?. Crit Care 6, P126 (2002). https://doi.org/10.1186/cc1581
- Mechanical Ventilation
- Subcutaneous Route
- Vasopressor Support
- Therapeutic Anticoagulation