PMID- 33641194
OWN - NLM
STAT- MEDLINE
DCOM- 20211227
LR  - 20211227
IS  - 1875-9114 (Electronic)
IS  - 0277-0008 (Linking)
VI  - 41
IP  - 5
DP  - 2021 May
TI  - Enoxaparin versus unfractionated heparin for venous thromboembolism prophylaxis 
      in renally impaired ICU patients.
PG  - 424-429
LID - 10.1002/phar.2518 [doi]
AB  - INTRODUCTION: Intensive care unit (ICU) patients with renal insufficiency are 
      more likely to develop venous thromboembolism and are at an increased risk for 
      bleeding. There is conflicting data on whether enoxaparin or unfractionated 
      heparin (UFH) is preferred for preventing thromboembolism in this population. 
      Therefore, the purpose of this study was to evaluate the safety of prophylactic 
      enoxaparin versus UFH in ICU patients with renal impairment. METHODS: We 
      conducted a single-center, retrospective cohort study of ICU patients with renal 
      impairment who received venous thromboembolism prophylaxis with either enoxaparin 
      or UFH. Patients were included if they were at least 18 years of age, had renal 
      impairment (acute kidney injury, severely decreased renal function, or end-stage 
      renal disease), and an ICU length of stay >/=72 h. The primary outcome was the 
      proportion of patients experiencing a major bleeding event, including fatal 
      bleed, symptomatic bleed in a critical area, or bleeding causing a >/=2 g/dl 
      decrease in hemoglobin leading to a transfusion of >/=2 units of packed red blood 
      cells. RESULTS: A total of 460 patients were included in the study. Of these, 231 
      received enoxaparin and 229 received UFH. In the unadjusted analysis, there was 
      no difference in major bleeding events observed with enoxaparin compared to UFH 
      (29.4% vs. 22.3%; p = 0.08) or rates of venous thromboembolism (4.3% vs. 3.5%; 
      p = 0.64), respectively. After adjusting for confounding factors, enoxaparin 
      showed a significant increase in major bleeding (OR: 1.84; 95% CI: 1.11 - 3.04; 
      p = 0.02). CONCLUSION: Thromboprophylaxis with enoxaparin in critically ill 
      patients with renal impairment was associated with an increased risk of major 
      bleeding compared to UFH.
CI  - (c) 2021 Pharmacotherapy Publications, Inc.
FAU - DeBiase, Christopher
AU  - DeBiase C
AD  - Ascension St. John Hospital, Detroit, MI, USA.
FAU - Giuliano, Christopher A
AU  - Giuliano CA
AUID- ORCID: 0000-0002-0540-785X
AD  - Ascension St. John Hospital, Detroit, MI, USA.
AD  - Eugene Applebaum College of Pharmacy, Wayne State University, Detroit, MI, USA.
FAU - Doshi, Mitesh
AU  - Doshi M
AD  - Ascension St. John Hospital, Detroit, MI, USA.
FAU - Ganoff, Michelle
AU  - Ganoff M
AD  - Ascension St. John Hospital, Detroit, MI, USA.
FAU - Alexander Paxton, Renee
AU  - Alexander Paxton R
AD  - Ascension St. John Hospital, Detroit, MI, USA.
LA  - eng
PT  - Journal Article
DEP - 20210316
PL  - United States
TA  - Pharmacotherapy
JT  - Pharmacotherapy
JID - 8111305
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/adverse effects
MH  - *Enoxaparin/adverse effects
MH  - Hemorrhage/chemically induced/epidemiology
MH  - *Heparin/adverse effects
MH  - Humans
MH  - Intensive Care Units
MH  - *Renal Insufficiency/complications
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - *Venous Thromboembolism/prevention & control
OTO - NOTNLM
OT  - anticoagulants
OT  - bleeding
OT  - enoxaparin
OT  - renal insufficiency
OT  - unfractionated heparin
OT  - venous thromboembolism
EDAT- 2021/03/01 06:00
MHDA- 2021/12/28 06:00
CRDT- 2021/02/28 20:41
PHST- 2021/01/25 00:00 [revised]
PHST- 2020/11/04 00:00 [received]
PHST- 2021/02/13 00:00 [accepted]
PHST- 2021/03/01 06:00 [pubmed]
PHST- 2021/12/28 06:00 [medline]
PHST- 2021/02/28 20:41 [entrez]
AID - 10.1002/phar.2518 [doi]
PST - ppublish
SO  - Pharmacotherapy. 2021 May;41(5):424-429. doi: 10.1002/phar.2518. Epub 2021 Mar 
      16.