Routine Plasma Anti-Xa Monitoring is Required for Low-Molecular-Weight Heparins
Low-molecular-weight heparins are anticoagulants used in the treatment of thrombosis. They have effectiveness and safety profiles similar to those of unfractionated heparin but are considered an attractive alternative because of their predictable pharmacokinetic characteristics. In this article, we...
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| Veröffentlicht in: | Clinical pharmacokinetics 2010-09, Vol.49 (9), p.567-571 |
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| creator | Al-Sallami, Hesham S. Barras, Michael A. Green, Bruce Duffull, Stephen B. |
| description | Low-molecular-weight heparins are anticoagulants used in the treatment of thrombosis. They have effectiveness and safety profiles similar to those of unfractionated heparin but are considered an attractive alternative because of their predictable pharmacokinetic characteristics. In this article, we demonstrate the need for therapeutic monitoring of low-molecular-weight heparins by addressing evidence arising from the literature and from modelling and simulation. First, treatment targets for unfractionated heparin and enoxaparin sodium were identified. Then, 10 000 virtual patients were simulated and the rate of treatment success was calculated. Treatment success was found to be similar between the two drugs (48% with unfractionated heparin and 54% with enoxaparin sodium). These results are consistent with empirical evidence from the literature and reflect the inadequacy of current dosing strategies in achieving desired biomarker targets. These results, along with recent advances in Bayesian forecasting techniques, support the need for routine monitoring and dose individualization of enoxaparin sodium in order to improve treatment success. |
| doi_str_mv | 10.2165/11532960-000000000-00000 |
| format | Article |
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They have effectiveness and safety profiles similar to those of unfractionated heparin but are considered an attractive alternative because of their predictable pharmacokinetic characteristics. In this article, we demonstrate the need for therapeutic monitoring of low-molecular-weight heparins by addressing evidence arising from the literature and from modelling and simulation. First, treatment targets for unfractionated heparin and enoxaparin sodium were identified. Then, 10 000 virtual patients were simulated and the rate of treatment success was calculated. Treatment success was found to be similar between the two drugs (48% with unfractionated heparin and 54% with enoxaparin sodium). These results are consistent with empirical evidence from the literature and reflect the inadequacy of current dosing strategies in achieving desired biomarker targets. These results, along with recent advances in Bayesian forecasting techniques, support the need for routine monitoring and dose individualization of enoxaparin sodium in order to improve treatment success.</description><subject>Anticoagulants - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Complications and side effects</subject><subject>Current Opinion</subject><subject>Dosage and administration</subject><subject>Drug Monitoring</subject><subject>Drugs</subject><subject>Enoxaparin</subject><subject>Enoxaparin - therapeutic use</subject><subject>Factor Xa Inhibitors</subject><subject>General pharmacology</subject><subject>Heparin - therapeutic use</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Molecular Weight</subject><subject>Pharmacokinetics. Pharmacogenetics. 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Drug treatments</topic><topic>Pharmacology/Toxicology</topic><topic>Pharmacotherapy</topic><topic>Properties</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Al-Sallami, Hesham S.</creatorcontrib><creatorcontrib>Barras, Michael A.</creatorcontrib><creatorcontrib>Green, Bruce</creatorcontrib><creatorcontrib>Duffull, Stephen B.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical pharmacokinetics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Al-Sallami, Hesham S.</au><au>Barras, Michael A.</au><au>Green, Bruce</au><au>Duffull, Stephen B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Routine Plasma Anti-Xa Monitoring is Required for Low-Molecular-Weight Heparins</atitle><jtitle>Clinical pharmacokinetics</jtitle><stitle>Clin Pharmacokinet</stitle><addtitle>Clin Pharmacokinet</addtitle><date>2010-09</date><risdate>2010</risdate><volume>49</volume><issue>9</issue><spage>567</spage><epage>571</epage><pages>567-571</pages><issn>0312-5963</issn><eissn>1179-1926</eissn><coden>CPKNDH</coden><abstract>Low-molecular-weight heparins are anticoagulants used in the treatment of thrombosis. They have effectiveness and safety profiles similar to those of unfractionated heparin but are considered an attractive alternative because of their predictable pharmacokinetic characteristics. In this article, we demonstrate the need for therapeutic monitoring of low-molecular-weight heparins by addressing evidence arising from the literature and from modelling and simulation. First, treatment targets for unfractionated heparin and enoxaparin sodium were identified. Then, 10 000 virtual patients were simulated and the rate of treatment success was calculated. Treatment success was found to be similar between the two drugs (48% with unfractionated heparin and 54% with enoxaparin sodium). These results are consistent with empirical evidence from the literature and reflect the inadequacy of current dosing strategies in achieving desired biomarker targets. 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| ispartof | Clinical pharmacokinetics, 2010-09, Vol.49 (9), p.567-571 |
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| subjects | Anticoagulants - therapeutic use Biological and medical sciences Complications and side effects Current Opinion Dosage and administration Drug Monitoring Drugs Enoxaparin Enoxaparin - therapeutic use Factor Xa Inhibitors General pharmacology Heparin - therapeutic use Humans Internal Medicine Medical sciences Medicine Medicine & Public Health Molecular Weight Pharmacokinetics. Pharmacogenetics. Drug-receptor interactions Pharmacology. Drug treatments Pharmacology/Toxicology Pharmacotherapy Properties |
| title | Routine Plasma Anti-Xa Monitoring is Required for Low-Molecular-Weight Heparins |
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