Abstract
Chronic Kidney Disease (CKD) patients usually require the use of anticoagulants for treatment or prevention of thromboembolic diseases. One such commonly used anticoagulant is enoxaparin. However, special attention is advised when using this drug for CKD patients because dosage adjustments may be needed. This prospective observational study was conducted in adult patients (> 18 years) with CKD stages 3 to 5 who were followed-up daily via prescriptions, medical records and laboratory tests. Enoxaparin doses, renal function and adverse drug events (ADEs) were thus monitored. Of the 87 ADEs identified in this study, 56 (64.3%) occurred in patients requiring enoxaparin prescription adjustment. Out of the 9 patients who had severe ADEs, 8 (88.9%) needed enoxaparin prescription adjustment. The results of this study suggest an overall increased risk of major bleeding and ADEs in patients requiring enoxaparin prescription adjustment. Further investigation of alternative dosing regimens in patients with CKD to maintain efficacy while reducing risks is imperative, as are studies on the utility of monitoring anti-factor Xa activity to guide dosing of enoxaparin. In addition, the role of clinical pharmacists in the management of CKD patients is crucial, as dose adjustments are often necessary.
Highlights
Chronic Kidney Disease (CKD) is a global public health problem that affects more than 20 million people in the US (Coresh et al, 2007)
Previous studies have demonstrated the better efficacy and safety of enoxaparin when compared to unfractionated heparin for the prevention of venous thromboembolism (Sherman et al, 2007)
Special attention is advised when using this drug for CKD patients, as dosage adjustment may be needed in cases with severe CKD, defined as creatinine
Summary
Chronic Kidney Disease (CKD) is a global public health problem that affects more than 20 million people in the US (Coresh et al, 2007). The mortality of patients with CKD is strongly related to their elevated incidence of cardiovascular disease (Levey et al, 2007). Patients suffer from a prothrombotic tendency associated with bleeding, because uremicrelated toxin exposure damages platelets in these patients (Jalal, Chonchol, Targher, 2010). Patients with CKD are at increased risk for adverse drug events (ADE) due to several reasons, including reduced ability to Anticoagulation therapy is frequently required for CKD patients, because of their greater risk of thromboembolic events (Jalal, Chonchol, Targher, 2010; Dager, Kiser, 2010). The use of enoxaparin in CKD patients may be unfavorable, because of its clearance via renal mechanisms and consequent accumulation of the drugs anticoagulant effect (Brophy, Wazny, Gehr, 2001; Verbeeck, Musuamba, 2009). Special attention is advised when using this drug for CKD patients, as dosage adjustment may be needed in cases with severe CKD, defined as creatinine
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