Subcutaneous enoxaparin for therapeutic anticoagulation in hemodialysis patients.
BACKGROUND
Information regarding dosing of low-molecular-weight heparins (LMWH) for therapeutic anticoagulation in hemodialysis (HD) patients is limited. The aim of this study was to retrospectively compare the safety and efficacy of enoxaparin versus unfractionated heparin (UFH) for therapeutic anticoagulation in HD patients.


METHODS
This retrospective chart review evaluated HD patients treated with subcutaneous enoxaparin that were matched based on the indication for anticoagulation with patients treated with intravenous UFH to achieve therapeutic anticoagulation. Primary outcome measures included 30-day incidence of thromboembolic events and major bleeding. Secondary outcomes included rehospitalization within 30days, length of stay, and mortality.


RESULTS
One hundred sixty-four patients were evaluated, 82 in each group. The average daily dose of enoxaparin used to target therapeutic levels was 0.7±0.2mg/kg/day (range=0.4-1). Comparing enoxaparin to UFH, there was no significant difference in major bleeding (6.1% vs 11%, p=0.4) or thromboembolism (0% vs 2.4%, p=0.5). Hospital length of stay was shorter in the enoxaparin group (20±53.8 vs 28.9±44.5days, p=0.02); there was no significant difference between groups in mortality or readmission. Adjusting for risk factors for bleeding there was a slight but statistically non-significant difference between enoxaparin versus UFH (OR=0.77, 95%CI: 0.2-3.5, p=0.73).


CONCLUSIONS
These findings suggest that therapeutic dosing of enoxaparin, in doses that ranged from 0.4-1mg/kg/day, was as safe as intravenous UFH in providing therapeutic anticoagulation in stable patients requiring chronic hemodialysis.
Clinical Pharmacy, University of California, San Francisco, CA, 2315 Stockton Blvd, Sacramento, CA 95815, USA. Electronic address: tiffany.pon@ucsf.edu.
Tiffany K
TK
Pon
University of California, Davis Medical Center, University of California, San Francisco, CA, USA; University of California, Davis School of Medicine, Touro Vallejo School of Pharmacy, 2315 Stockton Blvd, Sacramento, CA 95815, USA. Electronic address: william.dager@ucdmc.ucdavis.edu.
William E
WE
Dager
University of California, Davis Medical Center, Clinical Pharmacy, University of California, San Francisco, CA, USA; University of California, Davis School of Medicine, 2315 Stockton Blvd, Sacramento, CA 95815, USA. Electronic address: aaron.roberts@ucdmc.ucdavis.edu.
A Joshua
AJ
Roberts
Department of Internal Medicine, University of California, Davis Medical Center, Sacramento, CA, USA. Electronic address: rhwhite@ucdavis.edu.
Richard H
RH
White
D000925:Anticoagulants / Q000008:administration & dosage*; D017984:Enoxaparin / Q000008:administration & dosage*; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
D000925:Anticoagulants; D017984:Enoxaparin; D006495:Heparin, Low-Molecular-Weight
Enoxaparin; Hemorrhage; Heparin; Low-Molecular-Weight Heparin; Renal Dialysis; Thromboembolism