title: Treatment with Dalteparin is Associated with a Lower Risk of Bleeding Compared to Treatment with Unfractionated Heparin in Patients with Renal Insufficiency.
abstract: BACKGROUND
  Low molecular weight heparins (LMWHs) have been cautiously used in patients with chronic kidney disease (CKD) due to fear of accumulation. Dalteparin, however, has shown minimal tendency to accumulate in patients with CKD and may be safe to use in this patient population.
  
  
  OBJECTIVE
  We compared the incidence of clinically significant bleeding in patients with CKD receiving therapeutic doses of dalteparin to that of patients with CKD receiving therapeutic doses of UFH.
  
  
  METHODS
  This was a retrospective cohort study.
  
  
  METHODS
  Inpatients with CKD (GFR < 60 ml/min) who were treated with therapeutic dalteparin or UFH were included in the study
  
  
  METHODS
  Primary outcome was major bleeding within 10 days of anticoagulation, identified by ICD-9 code and confirmed by chart review. Demographic characteristics, laboratory values, comorbidities, prior bleeding history and inpatient medications were extracted for each admission from the electronic medical record. Logistic regression models were created to examine the association between choice of anticoagulant and bleeding rates, after adjustment for demographic and clinical characteristics.
  
  
  RESULTS
  Dalteparin-treated patients were significantly less likely to experience a major bleed than patients treated with UFH (1.14 % vs. 3.49 %, p < 0.001). The reduced likelihood of bleeding associated with dalteparin treatment remained significant after adjustment for patient characteristics (HR 0.39, 95 % CI: 0.21-0.70, p < 0.0001). A stratified analysis for subgroups with GFR< 30 mL/min and with GFR between 30 and 60 mL/min showed that dalteparin was still associated with lower odds of bleeding compared to treatment with unfractionated heparin, but the difference was nonsignificant for GFR< 30 (HR 0.35, 95 % CI: 0.11-1.15), even after adjustment (OR 0.37, 95 % CI: 0.11-1.22).
  
  
  CONCLUSIONS
  In patients with CKD, treatment with therapeutic dose dalteparin was associated with lower rates of bleeding than treatment with unfractionated heparin. For patients with severe CKD (GFR< 30), dalteparin was shown to be at least as safe as unfractionated heparin.
authors.affiliation: Division of Hematology-Oncology, Mount Sinai-Roosevelt Hospital, 1000 Tenth Avenue, New York, NY, USA. dpark@chpnet.org.
authors.forename: Doyun
authors.initials: D
authors.lastname: Park
authors.affiliation: Division of Hospital Medicine, Department of Medicine, Montefiore Medical Center of Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: William
authors.initials: W
authors.lastname: Southern
authors.affiliation: Division of Hospital Medicine, Department of Medicine, Montefiore Medical Center of Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Manuela
authors.initials: M
authors.lastname: Calvo
authors.affiliation: Division of Hematology, Department of Oncology, Montefiore Medical Center of the Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Margarita
authors.initials: M
authors.lastname: Kushnir
authors.affiliation: Department of Pharmacy, Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Clemencia
authors.initials: C
authors.lastname: Solorzano
authors.affiliation: Department of Pharmacy, Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Sinnet
authors.affiliation: Division of Hematology, Department of Oncology, Montefiore Medical Center of the Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Henny H
authors.initials: HH
authors.lastname: Billett
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D017985:Dalteparin / Q000009:adverse effects*; D005260:Female; D005919:Glomerular Filtration Rate; D006470:Hemorrhage / Q000139:chemically induced* / Q000209:etiology; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology; D012189:Retrospective Studies
chemical_list: D000925:Anticoagulants; D006493:Heparin; D017985:Dalteparin
keywords: bleed; dalteparin; heparin; renal insufficiency