PMID- 22345418
OWN - NLM
STAT- MEDLINE
DCOM- 20120611
LR  - 20190101
IS  - 1535-2900 (Electronic)
IS  - 1079-2082 (Linking)
VI  - 69
IP  - 5
DP  - 2012 Mar 1
TI  - Initiative to improve thromboprophylactic enoxaparin exposure in hospitalized 
      patients with renal impairment.
PG  - 390-6
LID - 10.2146/ajhp110319 [doi]
AB  - PURPOSE: The impact of a quality-improvement (QI) initiative to decrease the risk 
      of bleeding in renally impaired patients receiving enoxaparin prophylaxis for 
      venous thromboembolism (VTE) was evaluated. METHODS: A retrospective cohort with 
      a before-and-after study design was employed. Inclusion criteria included age 
      over 40 years, hospitalization exceeding six days, treatment with enoxaparin or 
      unfractionated heparin (UFH), and acute or chronic renal insufficiency. Major 
      bleeding included fatal bleeding, symptomatic bleeding requiring hemodynamic 
      support or causing a decrease of 2 g/dL or more in hemoglobin concentration, or 
      bleeding leading to the transfusion of at least 2 units of packed red blood 
      cells. The QI intervention restricted enoxaparin use in patients with a 
      creatinine clearance (CL(cr)) concentration of <30 mL/min and recommended UFH 
      instead. RESULTS: The rate of major bleeding in the preintervention group was 
      13.5% with enoxaparin compared with 4.1% with UFH (p = 0.005). The relative risk 
      (RR) of bleeding with enoxaparin compared with UFH was 3.21 (95% confidence 
      interval [CI], 1.40-7.34). In patients with a CL(cr) concentration of <30 mL/min, 
      the RR of bleeding with enoxaparin compared with UFH was 4.68 (95% CI, 
      1.06-20.59). The rate of major bleeding in the postintervention period was 9.5% 
      with enoxaparin or 4.5% with UFH (p = 0.15). The RR of bleeding in the 
      postintervention period was 0.64 (95% CI, 0.37-1.12). CONCLUSION: A QI initiative 
      that eliminated the use of enoxaparin for prophylaxis of VTE in patients with 
      renal impairment resulted in lower rates of major bleeding associated with 
      pharmacologic prophylaxis. No differences in the rate of in hospital VTE as a 
      result of the intervention were observed.
FAU - Elsaid, Khaled A
AU  - Elsaid KA
AD  - Department of Pharmaceutical Sciences,Massachusetts College of Pharmacy and 
      Health Sciences, Boston, MA 02115-5896, USA. khaled.elsaid@mcphs.edu
FAU - Collins, Christine M
AU  - Collins CM
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - England
TA  - Am J Health Syst Pharm
JT  - American journal of health-system pharmacy : AJHP : official journal of the 
      American Society of Health-System Pharmacists
JID - 9503023
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 9005-49-6 (Heparin)
RN  - AYI8EX34EU (Creatinine)
SB  - IM
MH  - Acute Disease
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/administration & dosage/adverse effects/*therapeutic use
MH  - Chronic Disease
MH  - Cohort Studies
MH  - Creatinine/blood/urine
MH  - Enoxaparin/administration & dosage/adverse effects/*therapeutic use
MH  - Female
MH  - Hemorrhage/*chemically induced/epidemiology
MH  - Heparin/administration & dosage/adverse effects/therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Quality Assurance, Health Care
MH  - Renal Insufficiency/complications
MH  - Retrospective Studies
MH  - Venous Thromboembolism/*prevention & control
EDAT- 2012/02/22 06:00
MHDA- 2012/06/12 06:00
CRDT- 2012/02/21 06:00
PHST- 2012/02/21 06:00 [entrez]
PHST- 2012/02/22 06:00 [pubmed]
PHST- 2012/06/12 06:00 [medline]
AID - 69/5/390 [pii]
AID - 10.2146/ajhp110319 [doi]
PST - ppublish
SO  - Am J Health Syst Pharm. 2012 Mar 1;69(5):390-6. doi: 10.2146/ajhp110319.