Background: The use of subcutaneous ENOXAPARIN is a usual method for preventing venous thromboembolism (VTE) in the intensive care unit (ICU) patients, but adequate absorption of the drug is not reliable due to the illness intensity, existing edema and hypoperfusion in these patients. The aim of this study was to compare the effect of intravenous ENOXAPARIN with subcutaneous ENOXAPARIN to prevent VTE in ICU patients. Methods: The current double-blind Randomized clinical trial was performed on 64 patients admitted to the ICU at Khatam-Al-Anbia Hospital in Zahedan, southeast of Iran. The patients were randomly assigned into each of the subcutaneous ENOXAPARIN and the intravenous ENOXAPARIN groups. The blood sampling was performed aseptically and then active factor Xa level was measured. Next, the intervention group received 0. 5 mg/kg of intravenous ENOXAPARIN for 10 days and the control group was injected subcutaneously the same dosage of drug. Four hours after the first injection and 12 hours after the last injection on the tenth day, the factor Xa level and the frequency of VTE incidence was measured again. Results: In all three measurement times, the active factor Xa level in the intravenous ENOXAPARIN group was lower than that of the subcutaneous group, but no significant difference was observed between the two groups and different times (P> 0. 05). Conclusion: The results of this study showed that the use of intravenous ENOXAPARIN is an effective way to prevent the VTE development in the ICU patients.

Background & Aims: Drug utilization evaluation (DUE) is used to assess how a drug is prescribed and administered. We studied the use of ENOXAPARIN, a low molecular weight heparin (LMWH) which is widely used in cardiovascular patients as prophylactic or curative treatment.Materials & Methods: In a retrospective study, medical records of 322 patients admitted to the hospital for nine consecutive months starting from July 2012 who had received ENOXAPARIN were reviewed. Purpose of administration and dosage were recorded and compared with published guidelines for ENOXAPARIN administration.Results: The mean patient age was 61.15±13.19.88 patients (27.3%) received ENOXAPARIN for prophylactic and 234 patients (72.7%) received it as curative treatment. Prophylactic dose in 18 patients (20.45%) was according to published guidelines and in 70 patients (79.55%) more than recommended dose. In those patients who had received ENOXAPARIN as curative treatment, in 134 patients (57.27%) it was in accordance with the recommended dose. in 95 patients (40.6%) it was less and in 5 patients (2.13%) was more than recommended dose. In three patients who had a glomerular filtration rate (GFR) less than 30 ml/min, two patients received more and one patient received less than appropriate dose.Conclusion: The results indicate that in a large percentage of patients administered dose of ENOXAPARIN as prophylactic use was more than guideline’s recommendations and conversely administrated dose for curative treatment was less than recommended dose.

Background and purpose: Drug utilization evaluation (DUE) is one of the most effective methods to assess the correct administration of drugs. ENOXAPARIN is one of the most commonly used anticoagulant which is widely used as prophylactic or curative treatment. The aim of this study was to evaluate the rational use of ENOXAPARIN in Mazandaran Heart Center. Materials and methods: In a retrospective study, demographic and clinical data of 200 patients who had received ENOXAPARIN in 2017 were collected on the basis of American Hospital Formulary Service (AHFS) drug information, UpToDate, and Medscape guidelines. Results: The mean age of patients was 61. 52 ± 13. 62 years. The dosing of ENOXAPARIN was according to guidelines in 163 (81. 5%) patients and outside the target ranges in 37 (18. 5%). Conclusion: In this study, the administration of ENOXAPARIN for therapeutic or prophylactic purposes was not according to guidelines in about one-fifth of the patients and it is necessary to determine the precise dosage.

Drug utilization evaluation (DUE) is an effective program to identify variability in drug use and to support interventions that will improve patient outcomes. The appropriate use of ENOXAPARIN, a low molecular weight heparin (LMWH), which is widely used as curative or preventive treatment of thromboembolic disorders was assessed in the study.A prospective DUE was carried out at Masih Daneshvari teaching hospital. Criteria for the appropriate use of ENOXAPARIN were used to evaluate prescription and administration patterns in this hospital.ENOXAPARIN utilization of 147 inpatients was reviewed. A total of 944 variables (70.92%) in the regimen, among all subjects, were rated as appropriate and 382 (28.70%) were rated as inappropriate for the conditions diagnosed.The results of this study showed that inappropriate dosing, administration and prescribing of ENOXAPARIN is rather common in masih hospital. Educational programs and implementation of protocols may be needed in the teaching hospitals to control prescribing patterns.

Background: Drug-drug interactions can often lead to preventable adverse drug events and hospitalization. However, the clinical outcome of a potential drug-drug interaction that may range from minor alterations to major toxicity or loss of effect is often unknown. Drugs with narrow therapeutic index are more susceptible to the outcomes of interactions. Anticoagulants are one of the drug groups prone to drug-drug interactions and have important side effects. in this retrospective study, the frequency of drug-drug interactions involving warfarin, heparin and ENOXAPARIN was investigated. Methods: Overall, 300 patients (including 55% males with an average age of 50. 75 years) participated in this study, and for each anticoagulant, 100 patient orders were randomly selected from the hospital system. Drug-drug interactions were evaluated using the Micromedex drug interaction checker. Results: A total of 1691 drug-drug interactions (306 major, 253 moderate, and 89 minor interactions) were recorded of which only 648 (average 2. 16) involved warfarin, heparin, or ENOXAPARIN. Most interactions were recorded in patients admitted to the cardiovascular surgery (n=312) and cardiology (n=119) wards. There was a significant relationship between the number of drugs and the frequency of interaction. warfarin had the highest number of interactions (n=388). Conclusion: The frequency of drug interactions is high in patients on anticoagulant therapy. The efficacy and safety of these drugs can be affected by drug interactions. Accordingly, these interactions should always be considered, especially in patients with multiple drug use. Efficient monitoring strategies should be employed to optimize treatment while reducing adverse effects.

Background and purpose: Burn patients are at high risk for thromboembolic events. According to recent studies, in most burn patients, standard dosage of ENOXAPARIN cannot be effective in preventing thromboembolic events. The aim of this retrospective study was to evaluate the compliance of ENOXAPARIN for the prevention of thromboembolic events in burn patients with the standard guidelines for management of burn in Sari Zare Hospital, Iran. Materials and methods: In this study, we reviewed the medical records of 61 burn patients admitted to Sari Zare Hospital for six consecutive months (2016) who had received ENOXAPARIN. Prescribed dose and monitoring at the time of administration of ENOXAPARIN were compared with standard guidelines for management of burn. Results: The mean age of patients was 47. 37± 15. 6 and they were mainly male (73. 8%). All patients received ENOXAPARIN subcutaneously for prevention of thromboembolic events. Prophylactic dose was in accordance with recommended dose in 57. 3% of the patients. Active anti-factor was not evaluated in any of the patients with body mass index (BMI) outside the normal range. The Platelet count was evaluated in all patients at the beginning and in 98% during the treatment. Drug interactions were reported in less than 10% of the patients with no side effects. Conclusion: In most burn patients with normal BMI, the administered dose of prophylactic ENOXAPARIN was not in accordance with the recommended dose. In patients out of normal range, the dose was not adjusted based on BMI. This could increase the risk of thromboembolic events or bleeding in these patients.

Purpose: ENOXAPARIN has been widely used as a choice drug for treatment and prevention of different coagulation disorders. Orally administered ENOXAPARIN encounters with gastrointestinal barrier because of its high water solubility, high molecular weight and significant negative charge. Since, the nano-liposomes has gained great interest for oral drug delivery, we decided to introduce the best protocol for preparing ENOXAPARIN nano-liposomes through in vitro characterization. Methods: Nano-liposomes were prepared by ethanol injection, thin film hydration, and double emulsion/solvent evaporation methods. Size distribution, zeta potential, loading efficiencies, and in vitro drug release of nano-liposomes were also studied. Results: The mean vesicle size was obtained under 100 nm, and the zeta potential was highly negative through all preparation methods. Nano-liposomes prepared by double emulsion/ solvent evaporation (DE) technique could entrap more of this hydrophilic drug (43 ± 7. 1 %), but through thin layer hydration (TL) and ethanol injection (EI) only 28. 4± 3. 2% and 17. 3 ± 2. 5% of drug could be loaded into synthesized carriers. Drug release from these carriers was also obtained 42. 17± 1. 72%, 29. 43± 0. 34% and 32. 27± 0. 14%, in 24 hours for EI, TL, and DE methods, respectively. Conclusion: Here, we can introduce double emulsion/solvent evaporation method as an acceptable method for ENOXAPARIN loading, although some toxicity and in-vivo tests are also necessary to fully understand the potential of this formulation.