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PHARMACOKINETICS AND PHARMACODYNAMICS

Correlation of Antifactor Xa Concentrations with Renal Function in Patients on Enoxaparin

Sheryl L. Chow, PharmD, Kimberly Zammit, PharmD, Kathleen West, PharmD, MaryAnne Dannenhoffer, PharmD and Angel Lopez-Candales, MD

From the University at Buffalo, State University of New York, Kaleida Health Systems, Buffalo, New York.

Enoxaparin is a low molecular weight heparin (LMWH) that has been shown to be effective in deep vein thrombosis, pulmonary embolism, and unstable angina. Because renal function plays an important role in the clearance of LMWH, the authors sought to investigate the effect of renal function on enoxaparin. This prospective multiple-dose study evaluated 18 patients with varying degrees of renal function initiated on enoxaparin 1 mg/kg subcutaneously every 12 hours. Peak blood levels of anti-Xa concentrations were obtained 4 ± 0.5 hours postdose after receiving at least three doses of enoxaparin. The median antifactor Xa levels were higher in patients with creatinine clearance (CLCr) <= 30 mL/min compared to CLCr >= 31 mL/min (1.34 IU/mL vs. 0.91 IU/mL, respectively, p < 0.05). A linear correlation was established between creatinine clearance and anti-Xa concentrations (p< 0.0005). On the basis of the data, the authors believe that a dose adjustment is necessary in patients receiving repeated doses of enoxaparin with CLCr <= 30 mL/min.

Key Words: Low molecular weight heparin • enoxaparin • antifactor Xa • renal function

Address for reprints: Sheryl L. Chow, Adjunct Clinical Assistant Professor, University at Buffalo, School of Pharmacy, Kaleida Health Systems, Millard Fillmore Hospital, Department of Pharmacy, 3 Gates Circle, Buffalo, NY 14209.


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