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- Title
Anti-Xa activity with local treatment protocols for acute coronary syndrome.
- Authors
Lyons, K. S.; Menown, I. B. A.
- Abstract
Enoxaparin is now the recommended antithrombotic treatment for patients with acute coronary syndromes (ACS). While plasma monitoring of the biological activity of enoxaparin is not usually required due to its predictable pharmacokinetics and pharmacodynamics, it may be assessed by measuring plasma anti-Xa levels (therapeutic range 0.5-1.2IU/ml). In patients with ACS, low anti-Xa activity is independently associated with increased 30-day mortality. Guidelines and licensing suggest an ACS treatment dose of 1 mg/kg bd, although in Northern Ireland, many local treatment protocols dose cap enoxaparin at 60mg bd to reduce bleeding risk. We studied 20 consecutive patients admitted with ACS. All received 60mg enoxaparin bd. Peak plasma anti-Xa activity was measured as described by Montelescot et al, 4-6 hours after administration of enoxaparin. Results: Of the 20 patients, 14 were male, mean TIMI risk score was 4.2/7 and mean weight was 81.9kg. One third (35%) of patients (5 male, 2 female) were found to have sub-therapeutic anti-Xa levels (mean 0.35 IU/ml, range 0.2-0.49 IU/ml). The remainder had anti-Xa levels within the therapeutic range (mean 0.73 IU/ml, range 0.5 - 1.12 IU/ ml). Mean weight was higher in those with sub-therapeutic compared with therapeutic anti-Xa levels (89.9 vs 77.6kg; p value = 0.041). 5 patients in the therapeutic group and 1 patient in the non-therapeutic group had impaired renal function (eGFR 30-60 mls/min). In conclusion, dose capping of enoxaparin at 60mg bd in ACS patients may result in a significant proportion achieving sub-therapeutic anti-Xa levels, potentially correlating with poorer outcome.
- Subjects
NORTHERN Ireland; FIBRINOLYTIC agents; CORONARY disease; PHARMACOKINETICS; HEART diseases; THERAPEUTICS
- Publication
Ulster Medical Journal, 2008, Vol 77, Issue 2, p135
- ISSN
0041-6193
- Publication type
Article