Pharmacokinetic Comparison of Subcutaneous and Intravenous Nadroparin Administration for Thromboprophylaxis in Critically Ill Patients on Vasopressors

CIHLÁŘ, Radek, Vladimír ŠRÁMEK, Adriána PAPIEŽ, Miroslav PENKA and Pavel SUK. Pharmacokinetic Comparison of Subcutaneous and Intravenous Nadroparin Administration for Thromboprophylaxis in Critically Ill Patients on Vasopressors. PHARMACOLOGY. BASEL: KARGER, 2020, vol. 105, 1-2, p. 73-78. ISSN 0031-7012. Available from: https://dx.doi.org/10.1159/000502847.

Basic information

• Original name: Pharmacokinetic Comparison of Subcutaneous and Intravenous Nadroparin Administration for Thromboprophylaxis in Critically Ill Patients on Vasopressors
• Authors: CIHLÁŘ, Radek (203 Czech Republic, belonging to the institution), Vladimír ŠRÁMEK (203 Czech Republic, belonging to the institution), Adriána PAPIEŽ (703 Slovakia, belonging to the institution), Miroslav PENKA (203 Czech Republic, belonging to the institution) and Pavel SUK (203 Czech Republic, guarantor, belonging to the institution).
• Edition: PHARMACOLOGY, BASEL, KARGER, 2020, 0031-7012.

Other information

• Original language: English
• Type of outcome: Article in a journal
• Field of Study: 30104 Pharmacology and pharmacy
• Country of publisher: Switzerland
• Confidentiality degree: is not subject to a state or trade secret
• WWW: URL
• Impact factor: Impact factor: 2.547
• RIV identification code: RIV/00216224:14110/20:00115304
• Organization unit: Faculty of Medicine
• Doi: http://dx.doi.org/10.1159/000502847
• UT WoS: 000508853800010
• Keywords in English: Low molecular weight heparin; Pharmacokinetics; Anti-factor Xa activity; Thromboembolism; Prophylaxis; Vasopressors
• Tags: 14110122, 14110212, rivok
• Tags: International impact, Reviewed

Abstract

Introduction: Critically ill patients are exposed to a high risk of developing thromboembolism. Moreover, standard prophylaxis with subcutaneous (SC) heparin is less efficient in patients requiring vasopressors. The aim is a comparison of pharmacokinetics between SC and intravenous (IV) applied nadroparin. Methods: Thirty-eight ventilated ICU patients requiring vasopressor support were randomized into a single dose of nadroparin 3,800 IU (0.4 mL) subcutaneously (SC group) or 1,900 IU (0.2 mL) intravenously (IV group). Anti-factor Xa activity (anti-Xa) was observed over 24 h; data are stated as median (IQR). Results: Peak anti-Xa was significantly higher in the IV group 0.42 (0.39-0.43) IU/mL than in the SC group 0.16 (0.09-0.18) IU/mL (p < 0.001). There was a trend towards higher area under the curve (AUC) of anti-Xa in the SC group 1.41 (0.41-1.80) IU/mL x h than in the IV group 1.04 (0.93-1.13) IU/mL x h (p = 0.08). In the SC group, there was a negative correlation between anti-Xa AUC and both capillary refill time Xa (r = -0.86) and norepinephrine dose (r = -0.68). In the IV group, anti-Xa decrease half-life was 1.6 (1.4-2.0) h. Conclusions: IV administration of 1,900 IU of nadroparin led to a predictable effective peak anti-Xa. After SC administration, anti-Xa was heterogeneous and significantly influenced by peripheral perfusion.