Thursday, July 26, 2007

New study stresses importance of proper dosing for anticoagulants
by Kelly Winget, DCRI Communications

A recent study found that approximately half the patients who receive enoxaparin anticoagulants after heart attacks were not receiving the correct dose. Researchers also found that excess dosing is linked with an increased risk for serious bleeding.

The analysis, which reviewed data from the CRUSADE* registry, was published in the July 23 Archives of Internal Medicine.

The DCRI’s Dr. Nancy Allen LaPointe, lead author of the study, found that most guidelines for anticoagulants focus on how to choose the best drug instead of considering appropriate dosing.

“It's important that we not just look at getting the appropriate drugs into the patients, but also that we try to get the most appropriate dose into the patients so we can maximize both efficacy and safety,” said Allen LaPointe.

While giving patients a higher dose of anticoagulants than they need to reduce blood clots can lead to greater risk of bleeding, patients could still experience problems from getting lower than recommended doses. However, the study did not focus on problems related to inadequate amounts of these drugs.

Researchers found that 47.3% of the 10,687 patients in the CRUSADE registry who were given enoxaparin had doses that varied by more than 10 mg from the recommended 2 mg/kg per day. Allen LaPointe believes patients might be receiving higher doses if their physicians didn’t factor in creatinine clearance or didn’t have an accurate weight for their patients. It is also important for physicians to change the dosing if the creatinine clearance levels change.

*CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC and AHA Guidelines)