Compliance with enoxaparin dosing and monitoring guidelines and the impact on patient length of stay: a pilot study

Dekker, Katharine R., Myers, Brooke L. and Barras, Michael A. (2016) Compliance with enoxaparin dosing and monitoring guidelines and the impact on patient length of stay: a pilot study. Therapeutic Drug Monitoring, 38 1: 59-63. doi:10.1097/FTD.0000000000000233


Author Dekker, Katharine R.
Myers, Brooke L.
Barras, Michael A.
Title Compliance with enoxaparin dosing and monitoring guidelines and the impact on patient length of stay: a pilot study
Journal name Therapeutic Drug Monitoring   Check publisher's open access policy
ISSN 1536-3694
0163-4356
Publication date 2016-02-01
Year available 2016
Sub-type Article (original research)
DOI 10.1097/FTD.0000000000000233
Open Access Status Not Open Access
Volume 38
Issue 1
Start page 59
End page 63
Total pages 5
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Collection year 2017
Language eng
Formatted abstract
Background: To investigate the compliance of prescribers with the state-wide Queensland Health (QH) guidelines for dosing and monitoring of enoxaparin, and to examine the effect that compliance has on the patients' length of stay (LOS) in hospital.

Methods: A 4-week retrospective study of consecutive inpatients who were administered enoxaparin for the treatment of an embolic disease. Data collected included influential patient demographics such as weight, renal function; details of antifactor Xa (aXa) monitoring, and patient LOS. All dosing and monitoring for each patient was compared to the current QH guidelines for enoxaparin usage; a multidisciplinary consensus document. The reasons for noncompliance were quantified and explored.

Results: A total of 67 inpatients were recruited. The median (range) age, weight, and creatinine clearance of patients were 66 years (18-92), 78.5 kg (47.6-182), and 64 mL/min (16-180), respectively. Only 20 (30%) patients received enoxaparin in compliance with QH guidelines, leaving 47 (70%) noncompliant. The median (range) LOS was 7 (2-58) days for the compliant group versus 15 days (2-101) for the noncompliant (P = 0.06, Mann-Whitney U test). A total of 10 (15%) patients were monitored for aXa; none of whom were monitored correctly. Twenty-eight patients did not receive monitoring when indicated (moderate or severe renal impairment, weight > 105 kg, or extended duration of therapy). In these patients, the median (range) LOS was 16.5 days (2-101).

Conclusions: Current prescribing of enoxaparin does not match state guidelines. Although not significant, there was a trend toward noncompliant patients having a greater LOS in hospital. The quality of aXa monitoring is suboptimal and barriers need to be explored. Larger studies are warranted.
Keyword Anticoagulation
Enoxaparin
Guidelines
Low molecular weight heparins
Monitoring
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
School of Pharmacy Publications
 
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