TY - JOUR
T1 - Smaller nadroparin dose reductions required for patients with renal impairment
T2 - A multicenter cohort study
AU - van Uden, Renate C. A. E.
AU - Jaspers, Tessa C. C.
AU - Meijer, Karina
AU - van Stralen, Karlijn J.
AU - Maat, Barbara
AU - Khorsand, Nakisa
AU - van Onzenoort, Hein A. W.
AU - Swart, Eleonora L.
AU - Huls, Harmen J.
AU - Mathôt, Ron A. A.
AU - Lukens, Michaël V.
AU - van den Bemt, Patricia M. L. A.
AU - Becker, Matthijs L.
N1 - Publisher Copyright: © 2024 The Authors
PY - 2024/4/1
Y1 - 2024/4/1
N2 - Background: Guidelines advise 50 % and 25 % dose reduction of the therapeutic nadroparin dose (86 IU/kg) in patients with eGFR 15–29 and 30-60 ml/min respectively. For monitoring, peak anti-Xa levels are suggested. Data lack whether this results in therapeutic anti-Xa levels or in anti-Xa levels that are comparable to those of patients without renal impairment. Aims: To determine dose ranges in patients with renal impairment that result in therapeutic anti-Xa levels and to determine the percentage of the 86 IU/kg dose that results in anti-Xa levels normally occurring in patients without renal impairment. Methods: A retrospective cohort study was conducted in five hospitals. Patients ≥18 years of age, with an eGFR ≥ 15 ml/min were included. The first correctly sampled peak (i.e. 3-5 h after ≥ third administration, regardless of dose per patient) was included. Simulated prediction models were developed using multiple linear regression. Results: 770 patients were included. eGFR and hospital affected the association between dose and anti-Xa level. The doses for peak anti-Xa levels of 0.75 IU/ml differed substantially between hospitals and ranged from 55 to 91, 65–359 and 68-168 IU/kg in eGFR 15–29, 30–60 and > 60 ml/min/1.73m2, respectively. In eGFR 15–29 and 30-60 ml/min/1.73m2, doses of 75 % and 91 % of 86 IU/kg respectively, were needed for anti-Xa levels normally occurring in patients with eGFR > 60 ml/min. Conclusion: We advise against anti-Xa based dose-adjustments as long as anti-Xa assays between laboratories are not harmonized and an anti-Xa target range is not validated. A better approach might be to target levels similar to eGFR > 60 ml/min/1.73m2, which are achieved by smaller dose reductions.
AB - Background: Guidelines advise 50 % and 25 % dose reduction of the therapeutic nadroparin dose (86 IU/kg) in patients with eGFR 15–29 and 30-60 ml/min respectively. For monitoring, peak anti-Xa levels are suggested. Data lack whether this results in therapeutic anti-Xa levels or in anti-Xa levels that are comparable to those of patients without renal impairment. Aims: To determine dose ranges in patients with renal impairment that result in therapeutic anti-Xa levels and to determine the percentage of the 86 IU/kg dose that results in anti-Xa levels normally occurring in patients without renal impairment. Methods: A retrospective cohort study was conducted in five hospitals. Patients ≥18 years of age, with an eGFR ≥ 15 ml/min were included. The first correctly sampled peak (i.e. 3-5 h after ≥ third administration, regardless of dose per patient) was included. Simulated prediction models were developed using multiple linear regression. Results: 770 patients were included. eGFR and hospital affected the association between dose and anti-Xa level. The doses for peak anti-Xa levels of 0.75 IU/ml differed substantially between hospitals and ranged from 55 to 91, 65–359 and 68-168 IU/kg in eGFR 15–29, 30–60 and > 60 ml/min/1.73m2, respectively. In eGFR 15–29 and 30-60 ml/min/1.73m2, doses of 75 % and 91 % of 86 IU/kg respectively, were needed for anti-Xa levels normally occurring in patients with eGFR > 60 ml/min. Conclusion: We advise against anti-Xa based dose-adjustments as long as anti-Xa assays between laboratories are not harmonized and an anti-Xa target range is not validated. A better approach might be to target levels similar to eGFR > 60 ml/min/1.73m2, which are achieved by smaller dose reductions.
KW - Anti-Xa level
KW - Haemorrhage
KW - Low-molecular-weight heparin
KW - Renal impairment
KW - Thrombosis
UR - http://www.scopus.com/inward/record.url?scp=85185605500&partnerID=8YFLogxK
U2 - 10.1016/j.thromres.2024.02.007
DO - 10.1016/j.thromres.2024.02.007
M3 - Article
C2 - 38377636
SN - 0049-3848
VL - 236
SP - 4
EP - 13
JO - Thrombosis research
JF - Thrombosis research
ER -