Evidence map›Paper›PMID 36040615›Full record

ArticleClinical pharmacokinetics2022

Optimising the Nadroparin Dose for Thromboprophylaxis During Hemodialysis by Developing a Population Pharmacodynamic Model Using Anti-Xa Levels.

Tessa C C Jaspers, Charlotte E Meijer, Louis Jean Vleming, Casper F M Franssen, Jeroen Diepstraten, Michael V Lukens, Patricia M L A van den Bemt, Barbara Maat, Nakisa Khorsand, Daniël J Touw and 1 more

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Article in Clinical pharmacokinetics, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.5field-weighted citation impact, top 33% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 2 citations in OpenAlex.

  1. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 4 institutions in 1 country.

Tessa C C JaspersDepartment of Hospital Pharmacy, Elisabeth TweeSteden Hospital, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands. t.c.c.jaspers@umcg.nl.ORCID 0000-0002-3939-1403
Charlotte E MeijerDepartment of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
Louis Jean VlemingDepartment of Internal medicine, Haga hospital, Leyweg 275, 2545 CH, The Hague, The Netherlands.
Casper F M FranssenDepartment of Internal medicine, University Medical Center Goningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.ORCID 0000-0003-1004-9994
Jeroen DiepstratenDepartment of Hospital Pharmacy, Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands.
Michael V LukensDepartment of Laboratory medicine, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
Patricia M L A van den BemtDepartment of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.ORCID 0000-0003-1418-5520
Barbara MaatDepartment of Hospital Pharmacy, Elisabeth TweeSteden Hospital, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands.ORCID 0000-0002-4833-0477
Nakisa KhorsandDepartment of Hospital Pharmacy, OLVG, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands.
Daniël J TouwDepartment of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.ORCID 0000-0002-1429-4789
Jeroen V KoomenDepartment of Anesthesiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.ORCID 0000-0001-7253-3998
University Medical Center Groningen · NLAmphia Ziekenhuis · NLElisabeth-TweeSteden Ziekenhuis · NLHaga Hospital · NL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionThe optimal nadroparin dose in patients undergoing hemodialysis is difficult to determine in clinical practice. Anti-Xa levels ≥ 0.4 IU/mL and < 2.0 IU/mL are suggested to prevent thrombus formation within the extracorporeal circuit whilst minimizing bleeding risk. We aimed to characterize the variability in the association between dose and anti-Xa levels, identify patient and dialysis characteristics that explained this variability, and optimize nadroparin dosing based on the identified characteristics.

methodsAnti-Xa samples were collected in patients who received intravenous nadroparin as thromboprophylaxis during routine dialysis sessions. A population pharmacodynamic model was developed using non-linear mixed-effects modelling. The percentage of patients ≥ 0.4 IU/mL (efficacy) and < 2.0 IU/mL (safety) was simulated for different doses, patient and dialysis characteristics.

resultsPatients (n = 137) were predominantly receiving standard hemodialysis (84.7% vs. hemodiafiltration 15.3%) and had a mean bodyweight of 76.3 kg (± 16.9). Lean body mass (LBM), mode of dialysis, and dialyzer partially explained between-subject variability in anti-Xa levels. Patients on hemodiafiltration and those receiving hemodialysis with a high LBM (≥ 80 kg) had a low probability (< 29%) of anti-Xa levels ≥ 0.4 IU/mL during the entire dialysis session. All patients, except hemodialysis patients with a low LBM (< 50 kg), had a high probability (> 70%) of peak anti-Xa levels < 2.0 IU/mL.

conclusionMainly patients receiving hemodiafiltration and those receiving hemodialysis with a high LBM can benefit from a higher nadroparin dose than currently used in clinical practice, while having anti-Xa levels < 2.0 IU/mL.

Indexed as

NadroparinVenous ThromboembolismAdministration, IntravenousAnticoagulantsFactor Xa InhibitorsHumansRenal DialysisAnticoagulantsFactor Xa InhibitorsNadroparin

Identifiers

PMID36040615
PMCPMC9652168
OpenAlexW4293561766

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.