Are there concerns with long-term care on prophylactic Clexane (enoxaparin) with a slightly elevated Partial Thromboplastin Time (PTT) of 27.8 seconds, Prothrombin Time (PT) of 15.3 seconds, and International Normalized Ratio (INR) of 1.05?

From the Guidelines

No concern is raised with the coagulation parameters (APTT 27.8, PT 15.3, INR 1.05) for a patient on prophylactic Clexane (enoxaparin), as these values are within normal ranges.

Key Points to Consider

• Low molecular weight heparins like Clexane primarily affect factor Xa activity rather than the clotting pathways measured by APTT, PT, and INR tests 1.
• Prophylactic Clexane is typically administered at doses of 40mg subcutaneously once daily for thromboprophylaxis in long-term care settings, as recommended by recent guidelines 1.
• Routine monitoring of coagulation parameters is not required for patients on prophylactic Clexane unless there are specific concerns about bleeding or thrombosis.
• If the patient has normal renal function, no dose adjustment is needed. However, if creatinine clearance is below 30 ml/min, consider reducing the dose to 20mg daily due to increased risk of accumulation, as suggested by studies on enoxaparin dosing in renal insufficiency 1.

Monitoring and Care

• Continue to monitor for signs of bleeding or thrombosis as part of routine care.
• Specific coagulation monitoring is unnecessary based on these results unless indicated by clinical suspicion of bleeding or thrombotic events.
• The patient's renal function should be regularly assessed to adjust the dose of Clexane if necessary, to minimize the risk of accumulation and bleeding complications, in line with recommendations for managing patients with renal insufficiency on low molecular weight heparins 1.

From the Research

Laboratory Results

• APTT: 27.8
• PT: 15.3
• INR: 1.05

Concerns with Prophylactic Clexane (Enoxaparin)

• The patient's laboratory results are within normal limits, indicating that the prophylactic dose of enoxaparin is not causing significant anticoagulation 2, 3, 4.
• However, it is essential to monitor the patient's laboratory results regularly to ensure that the enoxaparin dose is adequate and not causing excessive anticoagulation 3, 4.
• The use of enoxaparin as prophylaxis has been shown to be effective in reducing the risk of venous thromboembolism (VTE) in hospitalized patients 2, 5, 4.
• The choice of enoxaparin versus unfractionated heparin (UFH) for VTE prophylaxis depends on various factors, including the patient's renal function, bleeding risk, and clinical condition 3, 5, 6.

Comparison with Unfractionated Heparin (UFH)

• Studies have compared the efficacy and safety of enoxaparin versus UFH for VTE prophylaxis, with some showing similar efficacy and safety profiles 3, 5, 6.
• However, other studies have reported a higher risk of bleeding with UFH compared to enoxaparin 5.
• The use of enoxaparin may be preferred in patients with renal impairment or those at high risk of bleeding 3, 4.