Renal Impairment Hikes Enoxaparin-Related Bleeding Risk

Patients with moderate renal impairment are at increased risk of major bleeding resulting from enoxaparin treatment compared with patients who have normal kidney function, a study found.

Reliance on renal function for excretion of the anticoagulant may lead to its accumulation in patients with moderate renal impairment, but there is no dose adjustment recommended for these patients, the researchers pointed out.

Douglas D. DeCarolis, PharmD, of the Minneapolis Veterans Affairs Health Care System, and colleagues studied 164 patients treated with enoxaparin 1 mg/kg every 12 hours or 1.5 mg/kg once daily. They defined moderate renal impairment as a creatinine clearance (CrCl) of 30-50 mL/min and normal renal function as CrCl greater than 80 mL/min. The primary outcome was major bleeding, defined as any bleeding resulting in death, hospital admission, prolonged hospital stay, or an emergency department visit.

The primary outcome occurred in six (5.7%) of the 105 patients with normal kidney function and 13 (22%) of the 59 who had moderate renal impairment, Dr. DeCarolis's group reported in JAMA Internal Medicine (2012;172:1713-1718). In adjusted analyses, moderate renal impairment was associated with a nearly fourfold increased risk of major bleeding.

Neither group experienced recurrent thromboembolism.

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