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Pharmacokinetic profiles of intravenous versus subcutaneous administration of low molecular weight heparin for thromboprophylaxis in critically ill patients: A randomized controlled trial.

De Schryver, Nicolas;Serck, Nicolas;Eeckhoudt, Stéphane;Laterre, Pierre-François;Gérard, Ludovic;et.al.
(2022) Journal of Critical Care — Vol. 70, n° 1, p. 154029 [1-6] (2022)

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Authors
  • De Schryver, NicolasUCLouvain
    Author
  • Serck, Nicolas
    Author
  • Eeckhoudt, Stéphane
    Author
  • Laterre, Pierre-FrançoisUCLouvain
    Author
  • Wittebole, XavierUCLouvain
    Author
  • Gérard, Ludovicorcid-logoUCLouvain
    Author
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Abstract
(en) BACKGROUND: Low molecular weight heparins (LMWH) are recommended for thromboprophylaxis in ICU patients but often fail to reach adequate peak anti-Xa activity. OBJECTIVE: To compare the pharmacokinetic profiles of intravenous (IV) versus subcutaneous (SC) route of administration of LMWH. METHOD: This was a prospective, monocentric, randomized trial. Patients were randomized to the IV route of administration with a 4-h infusion of nadroparin 3800 IU or to the SC route of administration. Randomization was stratified according to the need for vasopressor or not. Anti-Xa activity was measured at baseline, and at 1, 2, 4, 6, 8, 12 and 24 h after the administration was started. RESULTS: Sixty patients were included, of whom 30 were randomized to the IV group and 30 to the SC route. Pharmacokinetic profiles were significantly different. Mean peak anti-Xa activity was 0.38 IU/ml in the IV group vs 0.20 IU/ml in the SC group (p < 0.001). Trough values and AUC (0-24 h) were similar in both groups. Pharmacokinetic profiles were similar whether patients received vasopressors or not. CONCLUSIONS: The IV route of administration with a 4-h infusion lead to a significantly higher peak anti-Xa activity without affecting trough value or the AUC (0-24 h). Whether the IV administration of LMWH might improve the efficacy of thromboprophylaxis requires further research. REGISTRATION: ClinicalTrials.gov, NCT04982055, retrospectively registered 08 July 2021, https://clinicaltrials.gov/ct2/show/NCT04982055?cond=NCT04982055&draw=2&rank=1.
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De Schryver, N., Serck, N., Eeckhoudt, S., Laterre, P.-F., Wittebole, X., & Gérard, L. (2022). Pharmacokinetic profiles of intravenous versus subcutaneous administration of low molecular weight heparin for thromboprophylaxis in critically ill patients: A randomized controlled trial. Journal of Critical Care, 70(1), 154029 [1-6]. https://doi.org/10.1016/j.jcrc.2022.154029 (Original work published 2022)