PMID- 24718051
OWN - NLM
STAT- MEDLINE
DCOM- 20150115
LR  - 20140512
IS  - 1879-2472 (Electronic)
IS  - 0049-3848 (Linking)
VI  - 133
IP  - 6
DP  - 2014 Jun
TI  - Subcutaneous enoxaparin for therapeutic anticoagulation in hemodialysis patients.
PG  - 1023-8
LID - S0049-3848(14)00166-2 [pii]
LID - 10.1016/j.thromres.2014.03.036 [doi]
AB  - BACKGROUND: Information regarding dosing of low-molecular-weight heparins (LMWH) 
      for therapeutic anticoagulation in hemodialysis (HD) patients is limited. The aim 
      of this study was to retrospectively compare the safety and efficacy of 
      enoxaparin versus unfractionated heparin (UFH) for therapeutic anticoagulation in 
      HD patients. MATERIALS AND METHODS: This retrospective chart review evaluated HD 
      patients treated with subcutaneous enoxaparin that were matched based on the 
      indication for anticoagulation with patients treated with intravenous UFH to 
      achieve therapeutic anticoagulation. Primary outcome measures included 30-day 
      incidence of thromboembolic events and major bleeding. Secondary outcomes 
      included rehospitalization within 30days, length of stay, and mortality. RESULTS: 
      One hundred sixty-four patients were evaluated, 82 in each group. The average 
      daily dose of enoxaparin used to target therapeutic levels was 0.7+/-0.2mg/kg/day 
      (range=0.4-1). Comparing enoxaparin to UFH, there was no significant difference 
      in major bleeding (6.1% vs 11%, p=0.4) or thromboembolism (0% vs 2.4%, p=0.5). 
      Hospital length of stay was shorter in the enoxaparin group (20+/-53.8 vs 
      28.9+/-44.5days, p=0.02); there was no significant difference between groups in 
      mortality or readmission. Adjusting for risk factors for bleeding there was a 
      slight but statistically non-significant difference between enoxaparin versus UFH 
      (OR=0.77, 95%CI: 0.2-3.5, p=0.73). CONCLUSIONS: These findings suggest that 
      therapeutic dosing of enoxaparin, in doses that ranged from 0.4-1mg/kg/day, was 
      as safe as intravenous UFH in providing therapeutic anticoagulation in stable 
      patients requiring chronic hemodialysis.
CI  - Copyright (c) 2014 Elsevier Ltd. All rights reserved.
FAU - Pon, Tiffany K
AU  - Pon TK
AD  - Clinical Pharmacy, University of California, San Francisco, CA, 2315 Stockton 
      Blvd, Sacramento, CA 95815, USA. Electronic address: tiffany.pon@ucsf.edu.
FAU - Dager, William E
AU  - Dager WE
AD  - University of California, Davis Medical Center, University of California, San 
      Francisco, CA, USA; University of California, Davis School of Medicine, Touro 
      Vallejo School of Pharmacy, 2315 Stockton Blvd, Sacramento, CA 95815, USA. 
      Electronic address: william.dager@ucdmc.ucdavis.edu.
FAU - Roberts, A Joshua
AU  - Roberts AJ
AD  - University of California, Davis Medical Center, Clinical Pharmacy, University of 
      California, San Francisco, CA, USA; University of California, Davis School of 
      Medicine, 2315 Stockton Blvd, Sacramento, CA 95815, USA. Electronic address: 
      aaron.roberts@ucdmc.ucdavis.edu.
FAU - White, Richard H
AU  - White RH
AD  - Department of Internal Medicine, University of California, Davis Medical Center, 
      Sacramento, CA, USA. Electronic address: rhwhite@ucdavis.edu.
LA  - eng
PT  - Journal Article
DEP - 20140324
PL  - United States
TA  - Thromb Res
JT  - Thrombosis research
JID - 0326377
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
MH  - Anticoagulants/*administration & dosage
MH  - Enoxaparin/*administration & dosage
MH  - Female
MH  - Heparin, Low-Molecular-Weight/administration & dosage
MH  - Humans
MH  - Injections, Subcutaneous
MH  - Male
MH  - Middle Aged
MH  - Renal Dialysis/*methods
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Enoxaparin
OT  - Hemorrhage
OT  - Heparin
OT  - Low-Molecular-Weight Heparin
OT  - Renal Dialysis
OT  - Thromboembolism
EDAT- 2014/04/11 06:00
MHDA- 2015/01/16 06:00
CRDT- 2014/04/11 06:00
PHST- 2014/01/06 00:00 [received]
PHST- 2014/03/05 00:00 [revised]
PHST- 2014/03/18 00:00 [accepted]
PHST- 2014/04/11 06:00 [entrez]
PHST- 2014/04/11 06:00 [pubmed]
PHST- 2015/01/16 06:00 [medline]
AID - S0049-3848(14)00166-2 [pii]
AID - 10.1016/j.thromres.2014.03.036 [doi]
PST - ppublish
SO  - Thromb Res. 2014 Jun;133(6):1023-8. doi: 10.1016/j.thromres.2014.03.036. Epub 
      2014 Mar 24.