title: Adverse outcomes of anticoagulant use among hospitalized patients with chronic kidney disease: a comparison of the rates of major bleeding events between unfractionated heparin and enoxaparin.
abstract: BACKGROUND
  Anticoagulation therapy is usually required in patients with chronic kidney disease (CKD) for treatment or prevention of thromboembolic diseases. However, this benefit could easily be offset by the risk of bleeding.
  
  
  OBJECTIVE
  To determine the incidence of adverse outcomes of anticoagulants in hospitalized patients with CKD, and to compare the rates of major bleeding events between the unfractionated heparin (UFH) and enoxaparin users.
  
  
  METHODS
  One year prospective observational study was conducted in patients with CKD stages 3 to 5 (estimated GFR, 10-59 ml/min/1.73 m(2)) who were admitted to the renal unit of Dubai Hospital. Propensity scores for the use of anticoagulants, estimated for each of the 488 patients, were used to identify a cohort of 117 pairs of patients. Cox regression method was used to estimate association between anticoagulant use and adverse outcomes.
  
  
  RESULTS
  Major bleeding occurred in 1 in 3 patients who received anticoagulation during hospitalization (hazard ratio [HR], 4.61 [95% confidence interval [CI], 2.05-10.35]). Compared with enoxaparin users, patients who received anticoagulation with unfractionated heparin had a lower mean [SD] serum level of platelet counts (139.95 [113] × 10(3)/µL vs 205.56 [123] × 10(3)/µL; P<0.001), and had a higher risk of major bleeding (HR, 4.79 [95% CI, 1.85-12.36]). Furthermore, compared with those who did not receive anticoagulants, patients who did had a higher in-hospital mortality (HR, 2.54 [95% CI, 1.03-6.25]); longer length of hospitalization (HR, 1.04 [95% CI, 1.01-1.06]); and higher hospital readmission at 30 days (HR, 1.79 [95% CI, 1.10-2.91]).
  
  
  CONCLUSIONS
  Anticoagulation among hospitalized patients with CKD was significantly associated with an increased risk of bleeding and in-hospital mortality. Hence, intensive monitoring and preventive measures such as laboratory monitoring and/or dose adjustment are warranted.
authors.affiliation: School of Pharmacy, Universiti Sains Malaysia, Penang, Malaysia.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Saheb Sharif-Askari
authors.affiliation: School of Pharmacy, Universiti Sains Malaysia, Penang, Malaysia.
authors.forename: Syed Azhar
authors.initials: SA
authors.lastname: Syed Sulaiman
authors.affiliation: School of Pharmacy, Universiti Sains Malaysia, Penang, Malaysia.
authors.forename: Narjes
authors.initials: N
authors.lastname: Saheb Sharif-Askari
authors.affiliation: Pharmacy Department, Dubai Health Authority, Dubai, United Arab Emirates.
authors.forename: Ali
authors.initials: A
authors.lastname: Al Sayed Hussain
authors.affiliation: Nephrology Unit, Dubai Hospital, Dubai, United Arab Emirates.
authors.forename: Mohammad Jaffar
authors.initials: MJ
authors.lastname: Railey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D015331:Cohort Studies; D017984:Enoxaparin / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000097:blood / Q000139:chemically induced*; D006493:Heparin / Q000009:adverse effects*; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D012307:Risk Factors; D013923:Thromboembolism / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D006493:Heparin