PMID- 25181525
OWN - NLM
STAT- MEDLINE
DCOM- 20150427
LR  - 20211021
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 9
IP  - 9
DP  - 2014
TI  - Adverse outcomes of anticoagulant use among hospitalized patients with chronic 
      kidney disease: a comparison of the rates of major bleeding events between 
      unfractionated heparin and enoxaparin.
PG  - e106517
LID - 10.1371/journal.pone.0106517 [doi]
LID - e106517
AB  - BACKGROUND: Anticoagulation therapy is usually required in patients with chronic 
      kidney disease (CKD) for treatment or prevention of thromboembolic diseases. 
      However, this benefit could easily be offset by the risk of bleeding. OBJECTIVES: 
      To determine the incidence of adverse outcomes of anticoagulants in hospitalized 
      patients with CKD, and to compare the rates of major bleeding events between the 
      unfractionated heparin (UFH) and enoxaparin users. METHODS: One year prospective 
      observational study was conducted in patients with CKD stages 3 to 5 (estimated 
      GFR, 10-59 ml/min/1.73 m(2)) who were admitted to the renal unit of Dubai 
      Hospital. Propensity scores for the use of anticoagulants, estimated for each of 
      the 488 patients, were used to identify a cohort of 117 pairs of patients. Cox 
      regression method was used to estimate association between anticoagulant use and 
      adverse outcomes. RESULTS: Major bleeding occurred in 1 in 3 patients who 
      received anticoagulation during hospitalization (hazard ratio [HR], 4.61 [95% 
      confidence interval [CI], 2.05-10.35]). Compared with enoxaparin users, patients 
      who received anticoagulation with unfractionated heparin had a lower mean [SD] 
      serum level of platelet counts (139.95 [113] x 10(3)/microL vs 205.56 [123] x 
      10(3)/microL; P<0.001), and had a higher risk of major bleeding (HR, 4.79 [95% CI, 
      1.85-12.36]). Furthermore, compared with those who did not receive 
      anticoagulants, patients who did had a higher in-hospital mortality (HR, 2.54 
      [95% CI, 1.03-6.25]); longer length of hospitalization (HR, 1.04 [95% CI, 
      1.01-1.06]); and higher hospital readmission at 30 days (HR, 1.79 [95% CI, 
      1.10-2.91]). CONCLUSIONS: Anticoagulation among hospitalized patients with CKD 
      was significantly associated with an increased risk of bleeding and in-hospital 
      mortality. Hence, intensive monitoring and preventive measures such as laboratory 
      monitoring and/or dose adjustment are warranted.
FAU - Saheb Sharif-Askari, Fatemeh
AU  - Saheb Sharif-Askari F
AD  - School of Pharmacy, Universiti Sains Malaysia, Penang, Malaysia.
FAU - Syed Sulaiman, Syed Azhar
AU  - Syed Sulaiman SA
AD  - School of Pharmacy, Universiti Sains Malaysia, Penang, Malaysia.
FAU - Saheb Sharif-Askari, Narjes
AU  - Saheb Sharif-Askari N
AD  - School of Pharmacy, Universiti Sains Malaysia, Penang, Malaysia.
FAU - Al Sayed Hussain, Ali
AU  - Al Sayed Hussain A
AD  - Pharmacy Department, Dubai Health Authority, Dubai, United Arab Emirates.
FAU - Railey, Mohammad Jaffar
AU  - Railey MJ
AD  - Nephrology Unit, Dubai Hospital, Dubai, United Arab Emirates.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Observational Study
DEP - 20140902
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*adverse effects
MH  - Cohort Studies
MH  - Enoxaparin/*adverse effects
MH  - Female
MH  - Hemorrhage/blood/*chemically induced
MH  - Heparin/*adverse effects
MH  - Hospitalization
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Middle Aged
MH  - Platelet Count
MH  - Proportional Hazards Models
MH  - Prospective Studies
MH  - Renal Insufficiency, Chronic/blood/complications/*drug therapy
MH  - Risk Factors
MH  - Thromboembolism/prevention & control
PMC - PMC4152258
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2014/09/03 06:00
MHDA- 2015/04/29 06:00
PMCR- 2014/09/02
CRDT- 2014/09/03 06:00
PHST- 2014/05/21 00:00 [received]
PHST- 2014/07/30 00:00 [accepted]
PHST- 2014/09/03 06:00 [entrez]
PHST- 2014/09/03 06:00 [pubmed]
PHST- 2015/04/29 06:00 [medline]
PHST- 2014/09/02 00:00 [pmc-release]
AID - PONE-D-14-21900 [pii]
AID - 10.1371/journal.pone.0106517 [doi]
PST - epublish
SO  - PLoS One. 2014 Sep 2;9(9):e106517. doi: 10.1371/journal.pone.0106517. eCollection 
      2014.