Bleeding during enoxaparin treatment more common with age over 75 years and severe renal insufficiency.
BACKGROUND
Severe renal insufficiency, defined as a creatinine clearance <30 mL/min, increases the risk for bleeding in elderly patients receiving enoxaparin (enoxaparin sodium) treatment.


METHODS
The risk/benefit ratios of enoxaparin and unfractionated heparin (UFH) in patients with acute myocardial infarction (AMI) aged >75 years were determined by investigating the parameters of efficacy (ischaemic event, lethal outcome), safety (bleeding events, renal insufficiency) or both (composite endpoint: ischaemic event or lethal outcome or bleeding event).


RESULTS
The study included 113 patients (59 male, 52.2%) with AMI aged >75 years; 36 of these patients received enoxaparin. In the patients who had severe renal insufficiency, bleeding events were more frequent in those receiving enoxaparin than in those patients who received UFH (3 vs 1, respectively; p = 0.024). Irrespective of the presence of renal insufficiency, bleeding events occurred more often in patients who received enoxaparin than in those who received UFH (13 vs 8, respectively; p = 0.007). The composite endpoint showed a nonsignificantly better profile in patients who received enoxaparin than in those who received UFH.


CONCLUSIONS
Although the use of enoxaparin (compared with UFH) and the presence of severe renal insufficiency significantly increased the occurrence of bleeding in patients with AMI aged >75 years, the risk/benefit difference in this population was not significant.
Despotovic
Nebojsa
N
Gerontology Department, City Hospital Zvezdara, Belgrade, Serbia.
Erceg
Predrag
P
Nikolic-Despotovic
Maja
M
Milosevic
Dragoslav P
DP
Davidovic
Mladen
M
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D023381:Endpoint Determination; D017984:Enoxaparin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy; D015995:Prevalence; D051437:Renal Insufficiency / Q000150:complications*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
D000925:Anticoagulants; D017984:Enoxaparin; D006493:Heparin