PMID- 15006942
OWN - NLM
STAT- MEDLINE
DCOM- 20040401
LR  - 20190514
IS  - 0012-3692 (Print)
IS  - 0012-3692 (Linking)
VI  - 125
IP  - 3
DP  - 2004 Mar
TI  - Anticoagulation in hospitalized patients with renal insufficiency: a comparison 
      of bleeding rates with unfractionated heparin vs enoxaparin.
PG  - 856-63
AB  - OBJECTIVES: To compare the rates of bleeding complications in patients with renal 
      insufficiency who receive anticoagulation therapy with the full therapeutic dose, 
      unfractionated heparin (UFH), or with twice-daily enoxaparin. SETTING: A 325-bed 
      community teaching hospital. STUDY TYPE: Retrospective cohort study. METHODS: The 
      medical records of all patients with renal insufficiency who received 
      anticoagulation therapy with UFH or enoxaparin during a 13-month period were 
      reviewed for the occurrence of major and minor bleeding. Incidence rates were 
      computed per 1,000-person days of anticoagulation therapy. Comparisons were made 
      across categories of renal insufficiency and other potential confounders. 
      RESULTS: A total of 620 patients with estimated glomerular filtration rates of < 
      60 mL/min were studied. Of these, 331 received anticoagulation therapy with UFH, 
      250 with enoxaparin, and 39 with both (not simultaneously). The major bleeding 
      rates were 26.3 per 1,000 person-days for UFH and 20.7 per 1,000 person-days for 
      enoxaparin. Major bleeding complications were similarly increased for both UFH 
      and enoxaparin therapy across categories of worsening renal insufficiency. 
      Patients with severe renal insufficiency while receiving enoxaparin had a 154% 
      excess incidence of minor bleeding compared to those receiving UFH (incidence 
      ratio, 2.54; 95% confidence interval, 1.01 to 6.36). Worsening renal 
      insufficiency, female gender, and prolonged duration of anticoagulation therapy 
      emerged as the main determinants for bleeding complications. CONCLUSION: Both the 
      twice-daily enoxaparin and UFH regimens are associated with comparable increases 
      in major bleeding complications in patients with renal dysfunction receiving 
      full-dose anticoagulation therapy. Both agents should be used with caution in 
      anticoagulation therapy for patients with renal insufficiency.
FAU - Thorevska, Natalya
AU  - Thorevska N
AD  - Department of Internal Medicine, Bridgeport Hospital, Bridgeport, CT 06610, USA.
FAU - Amoateng-Adjepong, Yaw
AU  - Amoateng-Adjepong Y
FAU - Sabahi, Ramin
AU  - Sabahi R
FAU - Schiopescu, Irina
AU  - Schiopescu I
FAU - Salloum, Anan
AU  - Salloum A
FAU - Muralidharan, Visvanathan
AU  - Muralidharan V
FAU - Manthous, Constantine A
AU  - Manthous CA
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Anticoagulants/*adverse effects
MH  - Enoxaparin/*adverse effects
MH  - Female
MH  - Glomerular Filtration Rate
MH  - Hemorrhage/*chemically induced
MH  - Heparin/*adverse effects
MH  - *Hospitalization
MH  - Humans
MH  - Kidney Failure, Chronic/*therapy
MH  - Male
MH  - Retrospective Studies
EDAT- 2004/03/10 05:00
MHDA- 2004/04/02 05:00
CRDT- 2004/03/10 05:00
PHST- 2004/03/10 05:00 [pubmed]
PHST- 2004/04/02 05:00 [medline]
PHST- 2004/03/10 05:00 [entrez]
AID - S0012-3692(15)31920-6 [pii]
AID - 10.1378/chest.125.3.856 [doi]
PST - ppublish
SO  - Chest. 2004 Mar;125(3):856-63. doi: 10.1378/chest.125.3.856.