The use of low molecular weight heparin in a Sicilian teaching hospital

LMWH are replacing unfractionated heparin (UFH) for therapeutic anticoagulation owing to their more predictable pharmacokinetics and ease of use. Especially in Sicily, their prescription volume is steadily increasing in general practice, but little is known about their use in the hospital setting. We investigated LMWH use at the Policlinico Universitario P. Giaccone of Palermo by examining the records of drug dispensation to the wards in the years 2010-2012. From 2010 to 2012 the use of LMWH at Policlinico of Palermo remained stable with a mean of 71 DDD/100 bed days (range 69-73) of drugs dispensed. Enoxaparin, nadroparin and reviparin were the most prescribed molecules, accounting each one for a third of the prescriptions in 2012. Moreover, a minimal increase in the prescription of fondaparinux (Fx) and a decrease in that of UFH were noted, being the mean prescription rates in 2010-2012 7.2 and 25 DDD/100 bed days, respectively. In 2012, the costs were 28.832, 16.980 and 36.369 € for LMWH, Fx and UFH, respectively. As expected, the highest values of drug prescription were registered in orthopaedic surgery, general surgery, cardiology and intensive care units; high rates of prescription were noted also in geriatrics, plastic and obesity surgery, neurology and neurosurgery wards. Overall, in comparison with other Italian institutions, LMWH use at Policlinico of Palermo appears to be only slightly high. The variability of drug prescription among different wards requires further study to ascertain the prescriptive appropriateness and the adherence to existing guidelines.