Background Non-ST segment elevation acute coronary syndromes (NSTE-ACS) are a leading cause of morbidity and mortality from cardiovascular diseases. The need for anticoagulation during the acute phase is especially important, but balancing ischaemic and bleeding risk is challenging. The European Society of Cardiology provided periodic practices guidelines to guide clinicians in the management of NSTE-ACS: appropriate dosing of low molecular weight heparins (LMWH) or fondaparinux is provided.
Purpose We assessed the appropriateness of anticoagulation regimens in the acute phase of NSTE-ACS patients, to identify risks and implementation of our pharmaceutical care plan.
Material and methods We conducted a retrospective study on NSTE-ACS patients in three district general hospitals during a 3 month period (February–April 2014). Baseline characteristics, antiplatelets and anticoagulation regimens were recorded and analysed for trends in prescribing.
Results Medical charts for 179 patients were reviewed. 31 were excluded due to unclear or incomplete information about anticoagulation and hence148 patients were eligible for analysis. 19 patients did not receive any antithrombin agent. Fondaparinux was administrated to 84 patients and LMWH (ie, enoxaparin or dalteparin) to 45 patients. The baseline characteristics were well matched between the two groups. The antiplatelet regime did not differ significantly between the two groups. Among patients treated with LMWH, enoxaparin and dalteparin were administrated to 31 and 14 patients, respectively. Overall, 65% of patients received LMWH for more than 72 hours. For patients with normal renal function, 8 (20%) received 90–110% of the theoretical dose regimen (adequate dose), whereas 9 (22%) received a dose in excess (over 130% of the theoretical dose regimen) and 24 (58%) received a lower than recommended dose (less than 90%). For patients with severely reduced kidney function (4), 3 received non-adequate dosing of LMWH.
Conclusion LMWH prescribing was inappropriate in terms of dose and duration according to the European Society of Cardiology guidelines. Variations in dosing are associated with a higher risk of ischaemic or bleeding events. To minimise dose alterations, a fixed dose of fondapariux should be opted for where available. If centres are to use a LMWH, we would advocate a tool to ensure accurate weight and renal function is taken into consideration prior to dosing.
No conflict of interest
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