Comparison of Intravenous Enoxaparin with Subcutaneous Enoxaparin in Preventing Venous Thromboembolism in Patients Admitted to Intensive Care Unit

  • Masoum Khoshfetrat Mail Department of Anesthesiology and Critical Care, Khatamolanbia Hospital, Zahedan University of Medical Sciences, Zahedan,Iran.
  • Majid Khorram Department of Anesthesiology and Critical Care, Shariati Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Aliakbar Keykha Faculty of Nursing, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Hossein Ansari Health Promotion Research Center, Department of Epidemiology and Biostatistics, Zahedan University of Medical Sciences, Zahedan, Iran.
Keywords:
Enoxaparin, Venous thromboembolism, Active coagulation factor Xa

Abstract

Background: The use of subcutaneous enoxaparin is a usual method for preventing venous thromboembolism (VTE) in the intensive care unit (ICU) patients, but adequate absorption of the drug is not reliable due to the illness intensity, existing edema and hypoperfusion in these patients. The aim of this study was to compare the effect of intravenous enoxaparin with subcutaneous enoxaparin to prevent VTE in ICU patients.
Methods: The current double-blind Randomized clinical trial was performed on 64 patients admitted to the ICU at Khatam- Al- Anbia Hospital in Zahedan, southeast of Iran. The patients were randomly assigned into each of the subcutaneous enoxaparin and the intravenous enoxaparin groups. The blood sampling was performed aseptically and then active factor Xa level was measured. Next, the intervention group received 0.5 mg/kg of intravenous enoxaparin for 10 days and the control group was injected subcutaneously the same dosage of drug. Four hours after the first injection and 12 hours after the last injection on the tenth day, the factor Xa level and the frequency of VTE incidence was measured again.
Results: In all three measurement times, the active factor Xa level in the intravenous enoxaparin group was lower than that of the subcutaneous group, but no significant difference was observed between the two groups and different times (P> 0.05).
Conclusion: The results of this study showed that the use of intravenous enoxaparin is an effective way to prevent the VTE development in the ICU patients.

References

[1] Crowther MA, Cook DJ, Griffith LE, Devereaux PJ, Rabbat CC, Clarke FJ, et al. Deep venous thrombosis: clinically silent in the intensive care unit. J crit care. 2005; 20(4):334-40.
[2] Ageno W, Becattini C, Brighton T, Selby R, Kamphuisen PW. Cardiovascular risk factors and venous thromboembolism: a meta-analysis. Circulation. 2008; 117(1):93-102.
[3] Stein PD, Beemath A, Olson RE. Obesity as a risk factor in venous thromboembolism. Am J Med. 2005;118(9):978-80.
[4] Vincent J-L, Abraham E, Kochanek P, Moore FA, Fink MP. Textbook of Critical Care E-Book: Elsevier Health Sciences; 2016.
[5] Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, et al. Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2008; 133(6):381S-453S.
[6] Katzung BG, Trevor AJ. Basic & clinical pharmacology: McGraw-Hill New York, NY; 2015.
[7] Bhatt DL, Lee BI, Casterella PJ, Pulsipher M, Rogers M, Cohen M, et al. Safety of concomitant therapy with eptifibatide and enoxaparin in patients undergoing percutaneous coronary intervention: results of the Coronary Revascularization Using Integrilin and Single bolus Enoxaparin Study. J Am Coll Cardiol. 2003; 41(1):20-5.
[8] Aslam MS, Sundberg S, Sabri MN, Cooke D, Lakier JB. Pharmacokinetics of intravenous/subcutaneous Enoxaparin in patients with acute coronary syndrome undergoing percutaneous coronary interventions. Catheter Cardiovasc Interv. 2002; 57(2):187-90.
[9] Cies JJ, Santos L, Chopra A. IV enoxaparin in pediatric and cardiac ICU patients. Pediatr Crit Care Med. 2014;15(2):e95-e103.
[10] Petrie S, Barras M, Lust K, Fagermo N, Allen J, Martin J. Evaluation of therapeutic enoxaparin in a pregnant population at a tertiary hospital. Intern med J. 2016; 46(7):826-33.
[11] Assadian A, Knöbl P, Hübl W, Senekowitsch C, Klingler A, Pfaffelmeyer N, et al. Safety and efficacy of intravenous enoxaparin for carotid endarterectomy: A prospective randomized pilot trial. J Vasc Surg. 2008; 47(3):537-42.
[12] Diab YA, Ramakrishnan K, Ferrell B, Chounoune R, Alfares FA, Endicott KM, et al. IV versus subcutaneous enoxaparin in critically ill infants and children: comparison of dosing, anticoagulation quality, efficacy, and safety outcomes. Pediatr Crit Care Med. 2017; 18(5):e207-e14.
[13] He P, Liu Y, Wei X, Jiang L, Guo W, Guo Z, et al. Comparison of enoxaparin and unfractionated heparin in patients with non-ST-segment elevation acute coronary syndrome undergoing percutaneous coronary intervention: a systematic review and meta-analysis. J Thorac Dis. 2018; 10(6):3308-18.
[14] Sanchez‐Pena P, Hulot JS, Urien S, Ankri A, Collet JP, Choussat R, et al. Anti‐factor Xa kinetics after intravenous enoxaparin in patients undergoing percutaneous coronary intervention: a population model analysis. Br J Clin Pharmacol. 2005; 60(4):364-73.
[15] Crary SE, Van Orden H, Journeycake JM. Experience with intravenous enoxaparin in critically ill infants and children. Pediatr Crit Care Med. 2008; 9(6):647-9.
Published
2020-05-04
How to Cite
1.
Khoshfetrat M, Khorram M, Keykha A, Ansari H. Comparison of Intravenous Enoxaparin with Subcutaneous Enoxaparin in Preventing Venous Thromboembolism in Patients Admitted to Intensive Care Unit. Arch Anesth & Crit Care. 6(2):60-4.
Section
Research Article(s)