Prescribing patterns and outcomes of enoxaparin for anticoagulation of atrial fibrillation

Abstract

Study Objective. To determine prescribing patterns and clinical outcomes of enoxaparin for anticoagulation of atrial fibrillation. Design. Retrospective analysis. Setting. A 650-bed, tertiary care, community teaching hospital. Subjects. Two hundred thirteen patients who received enoxaparin for thromboprophylaxis during an episode of atrial fibrillation. Intervention. Data collection on demographics, antithrombotic usage, and thrombotic and bleeding episodes from January-June 2001. Measurements and Main Results. Patients were characterized as having acute (51.6%) or chronic (48.4%) atrial fibrillation and were categorized according to stroke risk. Three enoxaparin dosing strategies had been prescribed: therapeutic, prophylactic, or adjusted. Prescribed regimens did not reflect stroke risk or type of atrial fibrillation but did reflect the degree of renal impairment. No episodes of stroke occurred with therapeutic enoxaparin dosages, but five strokes occurred among patients receiving prophylactic or adjusted dosages. Bleeding was similar with all dosing strategies in patients with adequate renal function and appeared to be more frequent in those with renal impairment. Conclusion. At a single hospital, wide variation in enoxaparin prescribing patterns existed. Further study is necessary to elucidate more fully the appropriate dosing strategy for this agent in the treatment of atrial fibrillation.