PMID- 30116544
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220318
IS  - 2054-3581 (Print)
IS  - 2054-3581 (Electronic)
IS  - 2054-3581 (Linking)
VI  - 5
DP  - 2018
TI  - Association Between Low-Molecular-Weight Heparin and Risk of Bleeding Among 
      Hemodialysis Patients: A Retrospective Cohort Study.
PG  - 2054358118792010
LID - 10.1177/2054358118792010 [doi]
LID - 2054358118792010
AB  - BACKGROUND: Low-molecular-weight heparins (LMWH) replaced unfractionated heparin 
      (UFH) in multiple indications. Although LMWH efficacy in hemodialysis was 
      demonstrated through multiple studies, their safety remains controversial. The 
      potential bioaccumulation in patients undergoing chronic hemodialysis raised the 
      question of bleeding risk among this population. OBJECTIVE: The aim of this study 
      was to evaluate bleeding risk among patients with chronic hemodialysis receiving 
      LMWH or UFH for the extracorporeal circuit anticoagulation. DESIGN: We conducted 
      a retrospective cohort study on data extracted from the Regie de l'assurance 
      maladie du Quebec (RAMQ) and Med-Echo databases from January 2007 to March 2013. 
      SETTING: Twenty-one hemodialysis centers in the province of Quebec, Canada. 
      PATIENTS: Chronic hemodialysis patients. MEASUREMENTS: Bleeding risk evaluated by 
      proportional Cox model for time-dependent exposure using demographics, 
      comorbidities, and drug use as covariates. METHODS: Minor, major, and total 
      bleeding events identified using International Classification of Diseases, Ninth 
      Revision (ICD-9)/International Classification of Diseases, Tenth Revision 
      (ICD-10) codes in the RAMQ and Med-Echo databases. Exposure status to LMWH or UFH 
      was collected through surveys at the facility level. RESULTS: We identified 5322 
      prevalent and incident patients with chronic hemodialysis. The incidence rate for 
      minor, major, and total bleeding was 9.45 events/1000 patient-year (95% 
      confidence interval [CI]: 7.61-11.03), 24.18 events/1000 patient-year (95% CI: 
      21.52-27.08), and 32.88 events/1000 patient-year (95% CI: 29.75-36.26), 
      respectively. We found similar risks of minor adjusted hazard ratio (HR: 1.04; 
      95% CI: 0.68-1.61), major (HR: 0.83; 95% CI: 0.63-1.10), and total bleeding (HR: 
      0.90; 95% CI: 0.72-1.14) when comparing LMWH with UFH. LIMITATIONS: Potential 
      misclassification of patients' exposure status and possible underestimation of 
      minor bleeding risk. CONCLUSION: LMWH was not associated with a higher minor, 
      major, or total bleeding risk. LMWH did not increase the risk of bleeding 
      compared with UFH for the extracorporeal circuit anticoagulation in hemodialysis. 
      The convenience of use and predictable effect made LMWH a suitable alternative to 
      UFH in hemodialysis.
FAU - Lazrak, Hind H
AU  - Lazrak HH
AD  - Centre de recherche Hopital Maisonneuve-Rosemont, Montreal, QC, Canada.
FAU - Rene, Emilie
AU  - Rene E
AD  - Centre de recherche Hopital Maisonneuve-Rosemont, Montreal, QC, Canada.
FAU - Elftouh, Naoual
AU  - Elftouh N
AD  - Centre de recherche Hopital Maisonneuve-Rosemont, Montreal, QC, Canada.
FAU - Lafrance, Jean-Philippe
AU  - Lafrance JP
AD  - Centre de recherche Hopital Maisonneuve-Rosemont, Montreal, QC, Canada.
AD  - Service de nephrologie, Hopital Maisonneuve-Rosemont, Montreal, QC, Canada.
AD  - Departement de Medecine, Universite de Montreal, QC, Canada.
LA  - eng
PT  - Journal Article
DEP - 20180802
PL  - England
TA  - Can J Kidney Health Dis
JT  - Canadian journal of kidney health and disease
JID - 101640242
PMC - PMC6088481
OTO - NOTNLM
OT  - chronic
OT  - hemorrhage
OT  - heparin
OT  - kidney failure
OT  - low-molecular-weight
OT  - pharmacoepidemiology
OT  - unfractionated heparin
COIS- Declaration of Conflicting Interests: The author(s) declared no potential 
      conflicts of interest with respect to the research, authorship, and/or 
      publication of this article.
EDAT- 2018/08/18 06:00
MHDA- 2018/08/18 06:01
PMCR- 2018/08/02
CRDT- 2018/08/18 06:00
PHST- 2018/01/31 00:00 [received]
PHST- 2018/06/18 00:00 [accepted]
PHST- 2018/08/18 06:00 [entrez]
PHST- 2018/08/18 06:00 [pubmed]
PHST- 2018/08/18 06:01 [medline]
PHST- 2018/08/02 00:00 [pmc-release]
AID - 10.1177_2054358118792010 [pii]
AID - 10.1177/2054358118792010 [doi]
PST - epublish
SO  - Can J Kidney Health Dis. 2018 Aug 2;5:2054358118792010. doi: 
      10.1177/2054358118792010. eCollection 2018.