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PS-099 Pharmaceutical intervention: enoxaparin use recommendations in patients with renal impairment
  1. J Urda-Romacho,
  2. JE Martinez-de la Plata,
  3. MA Castro-Vida,
  4. PJ Acosta-Robles,
  5. I Estepa-Moreno,
  6. MJ Gimeno-Jorda,
  7. A Martos-Rosa,
  8. A Fayet-Peret,
  9. O Urquizar-Rodriguez
  1. Hospital de Poniente, Pharmacy, El Ejido (Almería), Spain

Abstract

Background Enoxaparin is a low molecular weight heparin used in the treatment and prophylaxis of thromboembolic disease. It is metabolised in the liver and its elimination is mainly renal. Renal impairment results in a decrease in its elimination and then in a higher anticoagulant response. In patients with severe renal impairment dosage adjustment is recommended.

Purpose To analyse enoxaparin dose adjustment in patients with severe renal impairment based on clinical practice guideline recommendations.

Materials and methods We carried out a three-month prospective study in a 250-bed hospital. Patients treated with less than 40 mg enoxaparin were reviewed. Creatinine clearance (CrCl) <30 ml/min triggered a pharmaceutical intervention (PI), recommending 30 mg of enoxaparin for prophylaxis and 1 mg/kg/day for treatment of venous thromboembolism, unstable angina and acute non-Q wave myocardial infarction. All interventions were reported to the relevant physician through the electronic prescribing program. PIs were not performed when anticoagulation was being monitored by the haematology department. Data were obtained from the electronic prescribing (Unidosis Farmatools software application Dominion), laboratory software (GIPI) and electronic medical records (Ariadna).

Results During the study, enoxaparin was prescribed to 192 patients at doses higher than 40 mg/day. 12 (6.25%) had a CrCl < 30 ml/min. PIs were performed in 83.3% (10) of these renal cases, being accepted in 80% (8). No thromboembolic events were detected during the study. PIs not accepted were due to patient discharge or recovery of renal function.

Conclusions PIs improved prescribing, promoting the safe and proper use of enoxaparin, improving patient safety and reducing the risk of complications associated with overdose, with the consequent impact on the efficiency and quality of care in hospitalised patients.

No conflict of interest.

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