title: Pharmacokinetics of the low molecular weight heparin enoxaparin during 48 h after bolus administration as an anticoagulant in haemodialysis.
abstract: BACKGROUND
  The interest of low molecular weight heparins (LMWH) regarding bleeding risk is controversial in renal failure patients. In haemodialysis patients, there are very few data on the pharmacokinetics of LMWH after the end of the session. The aim of the study was to evaluate the duration of anticoagulation after bolus administration of the LMWH enoxaparin at the start of haemodialysis.
  
  
  METHODS
  The pharmacokinetics of enoxaparin were studied during the 48 h following a single bolus injection at the start of the dialysis session in 30 chronic haemodialysis patients. Pharmacokinetics were determined using a population approach (Non Linear Mixed Effects Modelling).
  
  
  RESULTS
  A single injection of enoxaparin at 60 U IU/kg (4000 +/- 455 IU) led to an anti-Xa activity higher than 1.2 IU/ml during the first 2 h of the session, and between 0.4 and 1.2 IU during the third and fourth hours. After the end of the session, anti-Xa activity remained higher than 0.4 IU/ml up to 10 h after injection, and higher than 0.1 IU/ml up to 24 h. The pharmacokinetic model showed that only weight improved the predicted vs observed anti-Xa activity plot. The model was used to simulate single and multiple dosing with decreased enoxaparin doses. Whatever the procedure, anti-Xa activity remained high (>0.22 +/- 0.99 UI/ml) up to 12 h after the start of the dialysis session.
  
  
  CONCLUSIONS
  These results suggest that haemodialysis patients receiving the LMWH enoxaparin during dialysis are at risk of bleeding up to 10 h after the injection.
authors.affiliation: Service de Néphrologie, Hôpital de la Conception, Marseille, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Guillet
authors.forename: Nicolas
authors.initials: N
authors.lastname: Simon
authors.forename: Jérôme José
authors.initials: JJ
authors.lastname: Sampol
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Lorec-Penet
authors.forename: Henri
authors.initials: H
authors.lastname: Portugal
authors.forename: Yvon
authors.initials: Y
authors.lastname: Berland
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dussol
authors.forename: Philippe
authors.initials: P
authors.lastname: Brunet
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000493:pharmacokinetics*; D017984:Enoxaparin / Q000008:administration & dosage / Q000493:pharmacokinetics*; D065427:Factor Xa Inhibitors; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D013997:Time Factors
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D065427:Factor Xa Inhibitors