PMID- 20442353
OWN - NLM
STAT- MEDLINE
DCOM- 20110121
LR  - 20220318
IS  - 1542-6270 (Electronic)
IS  - 1060-0280 (Linking)
VI  - 44
IP  - 6
DP  - 2010 Jun
TI  - Evaluation of bleeding risk in patients exposed to therapeutic unfractionated or 
      low-molecular-weight heparin: a cohort study in the context of a quality 
      improvement initiative.
PG  - 994-1002
LID - 10.1345/aph.1M615 [doi]
AB  - BACKGROUND: Bleeding associated with the use of unfractionated heparin (UFH) and 
      low-molecular-weight heparin (LMWH) can be a serious complication of health-care 
      management and should be the focus of quality improvement initiatives by 
      institutions. OBJECTIVE: To measure the incidence of bleeding with UFH and LMWH 
      and evaluate associated risk factors. METHODS: An observational cohort study was 
      conducted at a secondary and tertiary care hospital in Canada. All adults 
      receiving therapeutic doses of UFH or LMWH between April 2006 and March 2007, 
      with the exception of cardiac surgery patients, were included. Bleeding episodes 
      were classified per the GUSTO scale. RESULTS: Of 3066 hospitalizations, the 
      incidence of moderate or severe bleeding was 3.5%. Advanced age (OR 1.02, 95% CI 
      1.01 to 1.04; p < 0.001), female sex (OR 1.80, 95% CI 1.21 to 2.66; p = 0.003), 
      UFH instead of LMWH (OR 4.72, 95% CI 2.17 to 10.30; p < 0.001), creatinine 
      clearance (CrCl) (OR 0.89, 95% CI 0.84 to 0.95; p < 0.001, for a difference of 10 
      mL/min in CrCl), and supratherapeutic activated partial thromboplastin time 
      (aPTT) (OR 3.88, 95% CI 2.25 to 6.69; p < 0.001 for >180 vs <90 seconds) were 
      associated with a higher risk of bleeding in univariate analysis. In a 
      multivariate model without aPTT, CrCl (OR 0.90, 95% CI 0.85 to 0.96; p < 0.001, 
      for a difference of 10 mL/min in CrCl) and UFH (OR 2.35, 95% CI 1.11 to 4.98; p = 
      0.005) were significant predictors of bleeding. Among the bleeding episodes, 31% 
      were in a postoperative context and 15% were following a puncture. CONCLUSIONS: 
      Our findings show that CrCl and aPTT values, as well as the type of heparin used, 
      are significant predictors of bleeding in patients receiving UFH or LMWH and that 
      dosages should be adjusted to patient weight. The reason for all supratherapeutic 
      aPTT levels should be sought and corrective measures taken immediately.
FAU - Cossette, Benoit
AU  - Cossette B
AD  - Department of Pharmacy and Health Technology Assessment Unit, Centre hospitalier 
      universitaire de Sherbrooke, Sherbrooke, Quebec, Canada. 
      bcossette.chus@ssss.gouv.qc.ca
FAU - Pelletier, Marie-Eve
AU  - Pelletier ME
FAU - Carrier, Nathalie
AU  - Carrier N
FAU - Turgeon, Martin
AU  - Turgeon M
FAU - Leclair, Christian
AU  - Leclair C
FAU - Charron, Pierre
AU  - Charron P
FAU - Echenberg, Donald
AU  - Echenberg D
FAU - Fayad, Tania
AU  - Fayad T
FAU - Farand, Paul
AU  - Farand P
LA  - eng
PT  - Comparative Study
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20100504
PL  - United States
TA  - Ann Pharmacother
JT  - The Annals of pharmacotherapy
JID - 9203131
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Cohort Studies
MH  - Female
MH  - Hemorrhage/*chemically induced/diagnosis/*epidemiology
MH  - Heparin/adverse effects/analogs & derivatives/therapeutic use
MH  - Heparin, Low-Molecular-Weight/*adverse effects/therapeutic use
MH  - *Hospitalization
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Quality Indicators, Health Care/*standards
MH  - Risk Factors
EDAT- 2010/05/06 06:00
MHDA- 2011/01/22 06:00
CRDT- 2010/05/06 06:00
PHST- 2010/05/06 06:00 [entrez]
PHST- 2010/05/06 06:00 [pubmed]
PHST- 2011/01/22 06:00 [medline]
AID - aph.1M615 [pii]
AID - 10.1345/aph.1M615 [doi]
PST - ppublish
SO  - Ann Pharmacother. 2010 Jun;44(6):994-1002. doi: 10.1345/aph.1M615. Epub 2010 May 
      4.