Consumption Pattern of Enoxaparin in a Non-teaching Hospital
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Mohammadreza Rafati
,
Ebrahim Salehifar
,
Kaveh Jafari
,
Sima Sahraee
,
Amirmohammad Rafati
,
Razieh Avan
Abstract
Background: Drug use evaluation studies are conducted to assess the pattern of prescribing and administration of a drug. Deep vein thrombosis is one of the most important clinical issues around the world. This study examined the pattern of enoxaparin consumption, one of the most widely used anticoagulants, for the prevention and treatment of thrombosis in a non-teaching hospital. Methods: In this cross-sectional prospective study, 117 patients receiving enoxaparin in different wards of Imam Sajjad Hospital in Ramsar, Iran, were studied. Data on how to prescribe and use enoxaparin were recorded in a questionnaire designed according to UpToDate recommendations. Demographic variables, prophylaxis, and therapeutic indications, prophylaxis and treatment doses, interval, and monitoring information were evaluated. Finally, the results were compared with UpToDate suggestions. Results: The mean age of patients was 68.9 years, and 52.1% were men. Enoxaparin was prescribed for 35.9% of patients as prophylaxis, and 64.1% received this drug for treatment. Overall, prophylactic doses were inappropriately administered in 41.5% of patients. Improper therapeutic doses were also prescribed for 52% of subjects. Conclusion: The results of this study showed that the dosage and interval of enoxaparin administration were significantly inappropriate. It seems the prescribers must have more adherence to the valid and reliable enoxaparin guidelines for more rational practices.Gelfand EW. Intravenous immune globulin in autoimmune and inflammatory diseases. N Engl J Med. 2012 Nov 22;367(21):2015-25. DOI: 10.1056/NEJMra1009433
IUIS/WHO notice. Appropriate uses of human immunoglobulin in clinical practice. Clin Exp Immunol. 1983 May;52(2):417-22. PMID: 6861378; PMCID: PMC1535861.
Arumugham VB, Rayi A. Intravenous Immunoglobulin (IVIG) [Updated 2021 Dec 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554446/
Rutter A, Luger TA. High-dose intravenous immunoglobulins: an approach to treat severe immune-mediated and autoimmune skin diseases. J Am Acad Dermatol. 2001 Jun. 44(6):1010-24. DOI: 10.1067/mjd.2001.112325
Lucas M, Lee M, Lortan J, Lopez-Granados E, MisbahS, Chapel H. Infection outcomes in patients with common variable immunodeficiency disorders: relationship to immunoglobulin therapy over 22 years. J Allergy Clin Immunol 2010;125(6): 1354-1360.e4. DOI: 10.1016/j.jaci.2010.02.040
Perez EE, Orange JS, Bonilla F, et al. Update on the use of immunoglobulin in human disease: A review of evidence. J Allergy Clin Immunol 2017;139(3S): S1-S46. DOI: 10.1016/j.jaci.2016.09.023
Yang L, Wu EY, Tarrant TK. Immune Gamma Globulin Therapeutic Indications in Immune Deficiency and Autoimmunity. Curr Allergy Asthma Rep 2016;16(8):55. DOI: 10.1007/s11882-016-0632-7
Vitiello G, Emmi G, Silvestri E, Di Scala G, Palterer B, Parronchi P. Intravenous immunoglobulin therapy: a snapshot for the internist. Intern Emerg Med 2019;14(7):1041–1049. DOI: 10.1007/s11739-019-02150-z
Ammann EM, Haskins CB, Fillman KM, et al. Intravenous immune globulin and thromboembolic adverse events: A systematic review and meta-analysis of RCTs. Am J Hematol 2016 ;91(6):594-605. DOI: 10.1002/ajh.24358
Guo Y, Tian X, Wang X, Xiao Z. Adverse Effects of Immunoglobulin Therapy. Front Immunol. 2018 Jun 8;9:1299. PMID: 29951056. PMCID: PMC6008653. DOI: 10.3389/fimmu.2018.01299
Navarro, Robert. Chapter 8: Drug Utilization Review Strategies. In Managed Care Pharmacy Practice, published 2008, pp. 215 – 229.
Ruiz-Antorán B, Agustí Escasany A, Vallano Ferraz A, Danés Carreras I, Riba N, Mateu Escudero S. Use of non-specific intravenous human immunoglobulins in Spanish hospitals; the need for a hospital protocol. Eur J Clin Pharmacol. 2010 Jun;66(6):633–41. DOI: 10.1007/s00228-010-0800-y
Sohrevardi S, Shafiei A, Mirzania S. Intravenous Immunoglobulin: A Drug Utilization Review at Shahid Sadoughi Hospital in Yazd. Journal of Pharmaceutical Care. 2015;2(4):170-6.
Alangari AA, Abutaleb MH, Albarraq AA, Al-Dhowailie AA. Intravenous immunoglobulin utilization in a tertiary care teaching hospital in Saudi Arabia. Saudi Med J. 2008;29(7):975-9. PMID: 18626524.
Dawoud T, Tatari H, Gebran N A utilization review of intravenous immunoglobulin in a tertiary care hospital in the United Arab Emirates. Eur J Hosp Pharm: Science and Practice 2012;19:286-288. doi: 10.1136/ejhpharm-2012-000070
https://www.fda.gov.ir/getattachement/aa8bb17d-4d16-4cf2-a065-a0debfe4e2431(1)-11
El Ajez RH, Mohamed AE, Gaber Ali H. Evidence-based evaluation of intravenous immunoglobulin utilization in paediatric patients in Qatar. J Pharm Health Serv Res. 2019; 10(3):271-5. [DOI:10.1111/jphs.12285].
Fakhari Z, Farsaei S, Sabzghabaee AM. Predicting Factors for the Pattern of Intravenous Immunoglobulin Utilization in a Middle Eastern University Hospital. J Res Pharm Pract. 2018;7(4):188-194.
Lee J. Drug use evaluation: Off-label use of immune globulin G. Drug use res & manage progr.2014.
Hanna K, Poulin-Costello M, Preston M, Maresky N. Intravenous immune globulin use in Canada. Can J Clin Pharmacol. 2003 Spring;10(1):11-6. PMID: 12687032.
Moradi M, Moti T. Drug use evaluation of human intravenous immunoglobulin (IVIG) in a teaching hospital in East of Iran. J Pharm Care. 2016;4:70–4.
Dashti-Khavidaki S, Khalili H, Farshadi F, Aghamohammadi A, Movahedi M, Hajibabaei M. Inpatient pediatric use of intravenous immunoglobulin at an academic medical center. Singapore Med J. 2008 Feb;49(2):147-9.
Rezaie N, Shajareh E, Motamed MR, Ghanbari B, Pakdaman N, Farasatinasab M. Intravenous Immunoglobin Utilization Study in a Teaching Hospital. Arch Iran Med. 2019 May 1;22(5):232–235.
Kargar, M., Nikahd, M., Amini, S., Heidari, K., Gholami, K. Intravenous Immunoglobulin Utilization in a Pediatric Tertiary Care Teaching Hospital in Iran. Iranian J Pharm Sci, 2019; 15(1): 57–66.
Lin MW, Kirkpatrick PE, Riminton DS. How intravenous immunoglobulin is used in clinical practice: audits of two Sydney teaching hospitals. Intern Med J. 2007; 37(5):308-14.
Mohammad Zadeh I, A, Atar Zadeh E, Arzani A, Tamaddoni A. Assessment of IVIG treatment in children and its complications, Babol, 1999-2004. JBUMS. 2006; 8 (2):32–35.
Constantine MM, Thomas W, Whitman L, Kahwash E, Dolan S, Smith S, Caudle CJ, Burton E, Anderson DR; Atlantic Collaborative Intravenous Immune Globulin Utilization Working Group. Intravenous immunoglobulin utilization in the Canadian Atlantic provinces: a report of the Atlantic Collaborative Intravenous Immune Globulin Utilization Working Group. Transfusion. 2007 Nov;47(11):2072-80.
Guo Y, Tian X, Wang X, Xiao Z. Adverse Effects of Immunoglobulin Therapy. Front Immunol. 2018;9:1299.
Stiehm ER. Adverse effects of human immunoglobulin therapy. Transfus Med Rev. 2013 Jul;27(3):171–8.
Elajez R, Ezzeldin A, Gaber H. Safety evaluation of intravenous immunoglobulin in pediatric patients: a retrospective, 1-year observational study. Ther Adv Drug Saf. 2019. 3;10:2042098619876736.
Azizi G, Abolhassani H, Asgardoon MH, Shaghaghi S, Negahdari B, Mohammadi J, Rezaei N, Aghamohammadi A. Managing patients with side effects and adverse events to immunoglobulin therapy. Expert Rev Clin Pharmacol. 2016;9(1):91–102.
Prasad A, Chaudhary S. Intravenous immunoglobulin in pediatrics: A review. Med. J. Armed Forces India (2014)70(3):277–80.
Winters JL, Brown D, Hazard E, Chainani A, Andrzejewski C Jr. Cost-minimization analysis of the direct costs of TPE and IVIg in the treatment of Guillain-Barré syndrome. BMC Health Serv Res. 2011 May 16;11:101.
| Files | ||
| Issue | Vol 9 No 1 (2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jppm.v9i1.12880 | |
| Keywords | ||
| LMWH DUE Enoxaparin Hypertension Appropriate | ||
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