Efficacy and Safety of Enoxaparin in Hospitalized Patients with Severe Renal Insufficiency
A study evaluating the effect of thromboprophylaxis with enoxaparin at a dose of 20 mg/day in adult patients with renal failure compared the incidence of venous thromboembolism (VTE) with published results in patients without renal insufficiency who were prophylactically treated with enoxaparin at a dose of 40 mg/day. The authors also focused on the incidence of bleeding.
Evaluated Patient Population and Study Aims
This retrospective cohort study included adult patients with current creatinine clearance (CLcr) < 30 ml/min, who were treated outside the surgical department and were prescribed subcutaneous enoxaparin for at least 3 days. These were patients undergoing deep vein thrombosis (DVT) prophylaxis according to ACCP recommendations. Other primary monitored parameters were the incidence of VTE (DVT or pulmonary embolism/PE) and bleeding (both mild and significant) during hospitalization.
A total of 160 patients with an average age of 77 were evaluated, 62% of whom were men. Their average body weight was 71 kg, 23% had CLcr < 15 ml/min, and 34% were on hemodialysis. The majority (79%) of patients were admitted to the internal medicine department, 21% to the intensive care unit. The average length of hospitalization was 10 days. Reasons for thromboprophylaxis were immobilization (97.5%), VTE/PE history (3.1%), myocardial infarction/stroke/congestive heart failure (33.1%), rheumatic fever/infectious disease (31.9%), malignant disease or immunosuppressive therapy (6.9%), and age > 75 years (73.8%).
Results
VTE was detected in 9 (5.6%) patients during hospitalization, all cases being DVT. In multivariate analysis, a past occurrence of VTE was associated with an increased risk. Bleeding occurred in 37 (23.1%) patients, of which 16 (10%) were serious (requiring transfusion or a hemoglobin drop of ≥ 20 g/l). A higher risk of bleeding was found in patients older than 75 years, while it was lower in patients with CLcr 15–29 ml/min.
Conclusion
In patients with renal insufficiency hospitalized in the internal medicine department or ICU who require thromboprophylaxis, administration of enoxaparin at a dose of 20 mg/day s.c. is associated with a VTE incidence of 5.6%, which corresponds to the results published in patients with normal renal function treated with enoxaparin at a dose of 40 mg/day s.c. The incidence of major bleeding with this treatment was 10%.
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Source: Karaoui L. R., Tawil S., Salameh P., Chamoun N. Enoxaparin 20 mg for thromboprophylaxis in severe renal impairment. J Int Med Res 2019; 47 (1): 225−234, doi: 10.1177/0300060518799896.
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