Enoxaparin Use and Adverse Events in Outpatients With a Continuous Flow Left Ventricular Assist Device at a Single Institution

Allison M Bernard; Paulino A Alvarez; Heather R Bream-Rouwenhorst; Kathleen E Horner; Alexandros Briasoulis; Laura C Czerniak

doi:10.1177/0897190021993382

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Enoxaparin Use and Adverse Events in Outpatients With a Continuous Flow Left Ventricular Assist Device at a Single Institution

Journal article

Peer reviewed

Enoxaparin Use and Adverse Events in Outpatients With a Continuous Flow Left Ventricular Assist Device at a Single Institution

Allison M Bernard, Paulino A Alvarez, Heather R Bream-Rouwenhorst, Kathleen E Horner, Alexandros Briasoulis and Laura C Czerniak

Journal of pharmacy practice, Vol.35(3), pp.422-426

06/01/2022

DOI: 10.1177/0897190021993382

PMID: 33648405

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Abstract

Patients with left ventricular assist devices (LVADs) are anticoagulated with warfarin and may receive enoxaparin bridging for a subtherapeutic international normalized ratio (INR). There is no guideline regarding enoxaparin bridging in LVAD patients and a dosing strategy to ensure efficacy and safety is uncertain. The objective was to characterize the use of enoxaparin bridging for subtherapeutic INRs and its impact on thrombotic or major bleeding events (MBE) in patients with an LVAD. A retrospective review from 6/1/17 to 6/30/18 was performed. Patients with an LVAD were excluded if they had less than 60 days of outpatient anticoagulation or age <18 years old. Patients were divided into 2 cohorts based on enoxaparin exposure. MBE and thrombotic events were classified as related to enoxaparin if events occurred while receiving enoxaparin and up to 7 days or 30 days, respectively, after discontinuation. Seventy-one LVAD patients met inclusion criteria and 50 patients received enoxaparin bridging. Therapeutic-dose enoxaparin was initiated at a mean INR of 1.8 for a mean duration of 2.8 days. In the enoxaparin exposure group, one MBE occurred 6 days after enoxaparin discontinuation, coinciding with an INR increase from 1.8 to 4.7. One thrombotic event occurred 2 days after enoxaparin discontinuation at an INR of 5.0. This institution's bridging strategy of therapeutic-dose enoxaparin with a short duration has a low rate of bleeding and thrombotic events. Additional prospective studies of anticoagulation bridging based on characteristics such as type of LVAD device are warranted.

Adolescent

Anticoagulants

Enoxaparin - adverse effects

Heart-Assist Devices - adverse effects

Hemorrhage - chemically induced

Hemorrhage - drug therapy

Hemorrhage - epidemiology

Humans

Outpatients

Prospective Studies

Retrospective Studies

Thrombosis - epidemiology

Thrombosis - etiology

Thrombosis - prevention & control

Details

Title: Subtitle: Enoxaparin Use and Adverse Events in Outpatients With a Continuous Flow Left Ventricular Assist Device at a Single Institution
Creators: Allison M Bernard - University of Iowa Health Care
Paulino A Alvarez - University of Iowa
Heather R Bream-Rouwenhorst - University of Iowa
Kathleen E Horner - University of Iowa
Alexandros Briasoulis - University of Iowa
Laura C Czerniak - University of Iowa Health Care
Resource Type: Journal article
Publication Details: Journal of pharmacy practice, Vol.35(3), pp.422-426
DOI: 10.1177/0897190021993382
PMID: 33648405
ISSN: 0897-1900
eISSN: 1531-1937
Language: English
Date published: 06/01/2022
Academic Unit: Pharmacy Practice and Science; Internal Medicine
Record Identifier: 9984557844802771

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3 Times Cited - Web of Science