Impact of stage 3B chronic kidney disease on thrombosis and bleeding outcomes
after orthopedic surgery in patients treated with desirudin or enoxaparin:
insights from a randomized trial.
Author(s): Shorr AF, Eriksson BI, Jaffer AK, Smith J.
Affiliation(s): Pulmonary and Critical Care Medicine, Washington Hospital Center, Washington, DC
20010, USA. andrew.shorr@gmail.com
Publication date & source: 2012, J Thromb Haemost. , 10(8):1515-20
BACKGROUND: Venous thromboembolism (VTE) remains a significant complication of
major orthopedic surgery, and chronic kidney disease (CKD) is common among
elderly patients undergoing total hip replacement (THR).
OBJECTIVES: The purpose of this study was to evaluate thrombosis and bleeding
outcomes in patients with stage 3B CKD treated with either desirudin or
enoxaparin after elective THR.
PATIENTS/METHODS: This was a post hoc subgroup analysis of a randomized,
multicenter, double-blind study of desirudin vs. enoxaparin in patients
undergoing elective THR.
RESULTS: Patients received either subcutaneous desirudin 15 mg twice daily or
subcutaneous enoxaparin 40 mg once daily. Of the 2078 randomized patients who
received study medication, 577 had stage 3B CKD or worse (27.8%), and the
proportion of these patients who experienced a major VTE in the enoxaparin
treatment group was found to be much higher than in the desirudin treatment group
(11.1% vs. 3.4%, model-adjusted odds ratio 3.52, 95% confidence interval
1.48-8.40, P=0.004). There was no statistically significant difference between
treatment groups in terms of rates of major bleeding, regardless of stage of
renal function.
CONCLUSIONS: CKD has been reported previously to increase the risk of bleeding
with anticoagulants, and these findings suggest that CKD may also increase the
risk of major VTE for patients treated with enoxaparin, but not for patients
treated with desirudin. Clinicians should consider the impact of CKD on the risk
of VTE when choosing a prophylaxis agent.
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