Abstract
BackgroundLow-molecular-weight heparins (LMWHs) are safe and effective anticoagulant options for cardiovascular patients when applied as body weight-adjusted doses. However, there are some barriers that make it difficult to implement weight-adjusted doses in clinical practice. Therefore, it is vital to learn the dosing practices of LMWH and its efficacy and safety in clinical practice.MethodsA retrospective study was conducted in cardiovascular inpatients who had received at least one dose of LMWH during a 6-month period. Appropriateness of LMWH dosing was determined and major clinical outcomes (major adverse vascular events and major bleeding) during hospitalization were evaluated.ResultsA total of 376 admissions representing 364 patients received LMWH treatment. Of these, 17.0% (64/376) of admissions did not have body weight records. Of the 312 admissions included for the outcome study, only 34 cases (10.9%) received the recommended doses of LMWH, while 51 cases (16.3%) received mild underdoses, 223 cases (71.5%) received major underdoses and 4 (1.3%) received excess doses. There were 10 major adverse vascular events, which occurred more often in patients receiving excess doses of LMWH than in patients receiving recommended, mild or major underdoses (50%, 2.9%, 2.0% and 2.7%, respectively, P < 0.001). After multivariable analysis, severe renal insufficiency was an independent risk factor for major adverse vascular events [odds ratio (OR), 31.93; 95% confidence interval (CI), 5.99-170.30; P < 0.001]. No major bleeding was recorded.ConclusionsUnderdose of LMWH is commonly used in cardiovascular inpatients, which was suboptimal according to guidelines. Using LMWH at a fixed, low dose for treatment purposes in patients without severe renal insufficiency was not associated with a higher risk of adverse vascular events in the current study, though larger studies with extended follow-ups are required to fully assess the long-term consequences of LMWH underdosing.
Highlights
Low-molecular-weight heparins (LMWHs) are safe and effective anticoagulant options for cardiovascular patients when applied as body weight-adjusted doses
* Correspondence: haibindai@zju.edu.cn 1Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China Full list of author information is available at the end of the article (LMWHs) are safe and effective anticoagulant options for patients with venous thromboembolism (VTE), acute coronary syndrome (ACS), pulmonary embolism, unstable angina and non-ST-segment elevation myocardial infarction [2,3,4,5]. This is partly due to the fact that LMWHs have superior pharmacokinetic properties as compared to unfractionated heparin (UFH) and without the need for routine coagulation tests [6]
To our knowledge, the efficacy and safety of this “real word” clinical practice has not yet been studied. In this retrospective study from a Chinese teaching hospital, we examined the dosing practice of LMWHs, and determined the efficacy and safety of this practice in cardiovascular inpatients discharged from Jan 1 to Jun 30, 2010
Summary
Low-molecular-weight heparins (LMWHs) are safe and effective anticoagulant options for cardiovascular patients when applied as body weight-adjusted doses. In recent years several clinical trials have established, that low molecular weight heparins (LMWHs) are safe and effective anticoagulant options for patients with venous thromboembolism (VTE), acute coronary syndrome (ACS), pulmonary embolism, unstable angina and non-ST-segment elevation myocardial infarction [2,3,4,5]. This is partly due to the fact that LMWHs have superior pharmacokinetic properties as compared to unfractionated heparin (UFH) and without the need for routine coagulation tests [6]. Previous data have shown a relationship between LMWH dose, the intensity of anticoagulation and incidence of major hemorrhage, including intracranial bleeding [8]
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