No effect of norepinephrine dose on anti-Xa activity in critically ill patients

2020 ◽  
Vol 58 (04) ◽  
pp. 223-229
Author(s):  
Sjoerd D. Meenks ◽  
Norbert A. Foudraine ◽  
Kelly Broen ◽  
Jos L.M.L. le Noble ◽  
Paddy K.C. Janssen
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Norepinephrine Dose

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

Pharmacology ◽  
2019 ◽  
Vol 105 (1-2) ◽  
pp. 73-78
Author(s):  
Radek Cihlar ◽  
Vladimir Sramek ◽  
Adriana Papiez ◽  
Miroslav Penka ◽  
Pavel Suk
Keyword(s):  
Single Dose ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Area Under The Curve ◽  
Factor Xa ◽  
Capillary Refill Time ◽  
Peripheral Perfusion ◽  
Icu Patients ◽  
Capillary Refill ◽  
Norepinephrine Dose

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 × h than in the IV group 1.04 (0.93–1.13) IU/mL × 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.

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