Dosage reduction of low weight heparin in patients with renal dysfunction: Effects on anti-Xa levels and clinical outcomes

• Published in: PloS one 2020-10, Vol.15 (10), p.e0239222-e0239222
• Main Authors: Hornung, Paul, Khairoun, Meriem, Dekker, Friedo W, Kaasjager, Karin A.H, Huisman, Albert, Jakulj, Lily, Bos, Willem Jan W, Rosendaal, Frits R, Verhaar, Marianne C, Ocak, Gurbey
• Format: Article
• Language: English
• Subjects: Anticoagulants; Biology and Life Sciences; Bleeding; Clinical outcomes; Creatinine; Dosage; Dosage and administration; Drug dosages; Drug therapy; Epidemiology; Epidermal growth factor receptors; Glomerular filtration rate; Health hazards; Hemoglobin; Heparin; Hypertension; Internal medicine; Kidney failure; Laboratories; Low molecular weights; Medical records; Medicine; Medicine and Health Sciences; Molecular weight; Mortality; Nephrology; Patient outcomes; Pulmonary embolisms; Reduction; Renal function; Stroke; Thromboembolism; Thrombosis; Tomography
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0239222

To prevent bio-accumulation of low molecular weight heparins (LMWHs) in patients with decreased kidney function, dosage reduction and anti-Xa monitoring has been suggested. The aim of this study was to investigate the effect of pre-emptive dosage reduction of LMWH on anti-Xa levels. Furthermore, we investigated the association between anti-Xa levels and bleeding, thrombotic events and mortality. In this single center study, we followed 499 patients with decreased renal function in whom anti-Xa levels were measured. We observed how many patients had anti-Xa levels that fell within the reference range, with a standard protocol of a pre-emptive dosage reduction of LMWH (25% reduction in patients with an estimated glomerular filtration rate (eGFR) between 30 and 60 ml/min/1.73m.sup.2 and a reduction of 50% in patients with an eGFR below the 30 ml/min/1.73m.sup.2). Furthermore, Cox proportional hazard analyses were used to estimate hazard ratios to investigate the association between anti-Xa levels and major bleeding, thrombotic events and mortality within three months of follow-up. In a cohort of 499 patients (445 dalteparin and 54 nadroparin users), a pre-emptive dosage reduction of LMWH led to adequate levels of anti-Xa in only 19% of the patients (12% for the dalteparin users and 50% for nadroparin users). We did not find an association between anti-Xa levels and bleeding, thrombosis or mortality. Pre-emptive dosage reduction of LMWH leads to low anti-Xa levels in a large proportion, but this was not associated with bleeding, thrombosis or mortality.