Correlation of Treatment Dose Enoxaparin with Anti-Xa Concentrations In Adult Hemodialysis Inpatients

Indianapolis, IN

Although enoxaparin is used in hemodialysis patients there are no guideline recommendations for prophylactic or treatment dosing that correlate to the desired therapeutic range of anti-Xa concentration. In addition, there are no studies that have comprehensively evaluated the potential for drug accumulation (defined by increasing anti-Xa concentrations), its influence on bleeding risk, or mortality due to inadequate anticoagulation associated with treatment doses of enoxaparin. The available literature evaluating enoxaparin in patients receiving hemodialysis primarily examine enoxaparin pharmacokinetics with limited data assessing bleeding risk but not mortality. There is a need to define the correlation between enoxaparin doses given to the patients receiving hemodialysis and the corresponding anti-Xa concentrations as they relate to in hospital mortality and bleeding events. Our objectives for this study are to determine the correlation between full weight-based enoxaparin use and anti-Xa concentrations within the defined therapeutic target range for patients receiving chronic, scheduled hemodialysis, to evaluate the degree of change of anti-Xa concentrations when obtained pre- and post-dialysis, and to determine to what degree, if any, enoxaparin accumulates over the course of a treatment dose regimen as defined by an increase in anti-Xa concentration obtained pre-dialysis, post-dialysis, or on non-dialysis days.