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Cihlar, Radek; Sramek, Vladimir; Papiez, Adriana; Penka, Miroslav; Suk, Pavel

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

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  • Medientyp: E-Artikel
  • Titel: Pharmacokinetic Comparison of Subcutaneous and Intravenous Nadroparin Administration for Thromboprophylaxis in Critically Ill Patients on Vasopressors
  • Beteiligte: Cihlar, Radek; Sramek, Vladimir; Papiez, Adriana; Penka, Miroslav; Suk, Pavel
  • Erschienen: S. Karger AG, 2020
  • Erschienen in: Pharmacology
  • Sprache: Englisch
  • DOI: 10.1159/000502847
  • ISSN: 0031-7012; 1423-0313
  • Schlagwörter: Pharmacology ; General Medicine
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: <jats:p>&lt;b&gt;&lt;i&gt;Introduction:&lt;/i&gt;&lt;/b&gt; 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. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; 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). &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; 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 (&lt;i&gt;p&lt;/i&gt; &amp;#x3c; 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 × h than in the IV group 1.04 (0.93–1.13) IU/mL × h (&lt;i&gt;p&lt;/i&gt; = 0.08). In the SC group, there was a negative correlation between anti-Xa AUC and both capillary refill time Xa (&lt;i&gt;r&lt;/i&gt; = –0.86) and norepinephrine dose (&lt;i&gt;r&lt;/i&gt; = –0.68). In the IV group, anti-Xa decrease half-life was 1.6 (1.4–2.0) h. &lt;b&gt;&lt;i&gt;Conclusions:&lt;/i&gt;&lt;/b&gt; 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.</jats:p>