WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT
• Low-molecular-weight heparins (LMWHs) are effective anti-coagulants for the treatment of thromboembolic diseases.
• LMWHs are hydrophilic drugs with clearance related to lean body weight and renal function.
• Poor subject outcomes are linked to the inadequate dosing of LMWHs.
WHAT THIS STUDY ADDS
• Minimal adherence to the product label occured when dosing LMWHs.
• Hospitals preferred to dose-individualize using a variety of methods that included dose-capping, post-dose monitoring of anti-Xa activity and the use of lean body size descriptors to calculate a starting dose and renal function.
AIMS Low-molecular-weight heparins (LMWHs) are used globally to treat thromboembolic diseases; however, there is much debate on how to prescribe effectively for patients who have renal impairment and/or obesity. We aimed to investigate the strategies used to dose-individualize LMWH therapy.
METHODS We conducted an online survey of selected hospitals in Australia, New Zealand (NZ), United Kingdom (UK) and the United States (US). Outcome measures included: the percentage of hospitals which recommended that LMWHs were prescribed according to the product label (PL), the percentage of hospitals that dose-individualized LMWHs outside the PL based on renal function, body weight and anti-Xa activity and a summary of methods used to dose-individualize therapy.
RESULTS A total of 257 surveys were suitable for analysis: 84 (33%) from Australia, 79 (31%) from the UK, 73 (28%) from the US and 21 (8%) from NZ. Formal dosing protocols were used in 207 (81%) hospitals, of which 198 (96%) did not adhere to the PL. Of these 198 hospitals, 175 (87%) preferred to dose-individualize based on renal function, 128 (62%) on body weight and 48 (23%) by monitoring anti-Xa activity. All three of these variables were used in 29 (14%) hospitals, 98 (47%) used two variables and 71 (34%) used only one variable.
CONCLUSIONS Dose-individualization strategies for LMWHs, which contravene the PL, were present in 96% of surveyed hospitals. Common individualization methods included dose-capping, use of lean body size descriptors to calculate renal function and the starting dose, followed by post dose anti-Xa monitoring.