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    Poster Networking

    Venous Thromboembolism

    Poster Networking Session

    PB0464 - Smaller nadroparin dose reductions required for patients with renal impairment: a multicenter study

    Sunday, June 25, 2023
    18:30 – 19:30 ET
    Room: Exhibition

      Presenting Author(s)

    • Renate CAE van Uden, PharmD

      PhD student, PharmD, Hospital Pharmacist
      Department of Clinical Pharmacy and Pharmacology University Medical Center Groningen Groningen The Netherlands
      Haarlem, Noord-Holland, Netherlands

      • Co-Author(s)

    • TJ

      Tessa C.C. Jaspers

      PhD student, PharmD, Hospital Pharmacist
      Department of Clinical Pharmacy and Pharmacology University Medical Center Groningen Groningen The Netherlands
      Tilburg, Noord-Brabant, Netherlands

    • Karina Meijer, MD, PhD (she/her/hers)

      MD, PhD, Internist-haematologist, Professor
      Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
      Groningen, Groningen, Netherlands

    • Kv

      Karlijn J. van Stralen

      PhD
      Spaarne Gasthuis Academy Hoofddorp The Netherlands
      Hoofddorp, Noord-Holland, Netherlands

    • BM

      Barbara Maat

      PhD, PharmD, Hospital Pharmacist
      Department of Hospital Pharmacy Elisabeth TweeSteden Hospital Tilburg The Netherlands
      Tilburg, Noord-Brabant, Netherlands

    • NK

      Nakisa Khorsand

      PhD, PharmD, Hospital Pharmacist
      Department of Hospital Pharmacy OLVG Amsterdam The Netherlands
      Amsterdam, Noord-Holland, Netherlands

    • Hv

      Hein A.W. van Onzenoort

      PhD, PharmD, Hospital Pharmacist
      Department of Pharmacy Radboud University Medical Center Nijmegen the Netherlands
      Nijmegen, Gelderland, Netherlands

    • ES

      Eleonora L. Swart

      Professor, PhD, PharmD, Hospital Pharmacist
      Department of Hospital Pharmacy & Clinical Pharmacology Amsterdam UMC The Netherlands.
      Amsterdam, Noord-Holland, Netherlands

    • HH

      Harmen J. Huls

      PharmD
      Department of Hospital Pharmacy & Clinical Pharmacology Amsterdam UMC The Netherlands.
      Amsterdam, Noord-Holland, Netherlands

    • RM

      Ron A.A. Mathôt

      Professor, Clinical pharmacologist, PharmD, PhD
      Department of Hospital Pharmacy & Clinical Pharmacology, Amsterdam UMC – location AMC, The Netherlands.
      Amsterdam, Noord-Holland, Netherlands

    • Pv

      Patricia M.L.A. van den Bemt

      Professor, PhD, PharmD, Hospital Pharmacist
      Department of Clinical Pharmacy and Pharmacology University Medical Center Groningen Groningen The Netherlands
      Groningen, Groningen, Netherlands

    • MB

      Matthijs L. Becker

      PhD, PharmD, Hospital Pharmacist
      Pharmacy Foundation of Haarlem Hospitals Haarlem The Netherlands
      Haarlem, Noord-Holland, Netherlands

    Background: Guidelines vary in dosage recommendation for nadroparin in patients with renal impairment. Dutch guidelines advise 50 and 25% dose reduction of the registered dose (86IE/kg twice-daily) in eGFR 15-29 and 30-60mL/min respectively. Peak anti-Xa levels 0.5-1.0IU/mL are suggested. However, it is unclear which dosage results in anti-Xa levels of 0.5-1.0IU/mL or in anti-Xa levels that are comparable to those of patients with eGFR >60mL/min.

    Aims: To develop a prediction model for dose ranges in renal impairment that result in anti-Xa levels of 0.75IU/mL and to simulate dose ranges that result in similar anti-Xa levels compared to patients without renal impairment.

    Methods: A retrospective observational cohort study was conducted in five hospitals. Patients ≥18 years of age, with an eGFR ≥15mL/min were included. The first correct sample (i.e. 3-5h after ≥3rd nadroparin administration) per patient was included. Prediction models were developed using multiple linear regression. The Medical Research Ethics Committees United provided a waiver (W20.055).

    Results: 770 patients were included. eGFR and hospital affected the association between dose and anti-Xa level. Of the therapeutic dosed patients 41.6% of the anti-Xa levels were subtherapeutic (Table 1). Optimal dosages to achieve a peak anti-Xa level of 0.75IU/mL differed substantially between hospitals and ranged from 55-91, 65-359 and 68-168IU/kg twice-daily in patients with an eGFR 15-29, 30-60 and >60mL/min, respectively (Table 2). In patients with an eGFR 15-29 and 30-60mL/min, dosages of 69.7% and 109.7% respectively, were needed to achieve anti-Xa levels similar to patients with an eGFR >60mL/min.

    Conclusion(s): Anti-Xa targets were often not met in patients with eGFR >60mL/min, and levels differed substantially between hospitals. This hampers the usefulness of anti-Xa based dosing for renally impaired patients. A better approach might be to target levels similar to patients with eGFR >60mL/min. This is achieved by smaller dose reductions than currently advised.