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Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2019 January-February;178(1-2):22-30

DOI: 10.23736/S0393-3660.17.03704-4

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Association between renal dysfunction and the development of bleeding during prophylactic doses of low molecular weight heparins, a nested case-control study

Carmelo J. ESPINOSA ALMANZA 1, 2, , Hernando G. GAITAN DUARTE 1, 2, Oscar A. GUEVARA CRUZ 1, 2, Luis F. SANCHEZ SOLANILLA 3, 4, Rocio P. SANABRIA RODRIGUEZ 1, 3

1 Faculty of Medicine, National University of Colombia, Bogotá, Colombia; 2 Clinical Research Institute, Faculty of Medicine, National University of Colombia, Bogotá, Colombia; 3 Department of Internal medicine, San Rafael Clinical University Hospital, Bogotá, Colombia; 4 Universitary Foundation Juan N. Corpas, Bogotá, Colombia



BACKGROUND: The safety of prophylaxis with low-molecular-weight heparins (LMWHs) in patients with altered renal function is still undefined. The aim of this study was to establish whether reductions in the glomerular filtration rate (GFR) are associated with bleeding during LMWHs prophylaxis.
METHODS: A cohort of non-surgical patients during LMWH prophylaxis was assembled, on which we nested a case-control study. Cases was defined as patients with bleeding and 4 controls per case were randomly sampled from the population at risk the day of appearance of each case. For the analysis we used a multivariate model of conditional logistic regression.
RESULTS: From a total of 716 subjects 51 cases and 204 controls were taken, the bleeding was major in 39% of the cases. Cases and controls were similar in their basal characteristics, the average GFR in the cases was 72.4 mL/min compared to 72.5 mL/min between the controls (P=0.99). The multivariate analysis did not show an association between bleeding and abnormal GFR. The adjusted odds ratio was 1.27 [95% confidence interval (CI)] = [0.60-2.68]. However, an association was shown by the presence of thrombocytopenia (adjusted OR [95% CI] = 3.9 [1.6-9.6]); the administration of nonsteroidal anti-inflammatory drugs (NSAIDs) (adjusted OR [95% CI] = 3.4 [1.5-7.6]); and the use of antiplatelet drugs (adjusted OR [95% CI] = 2.4 [1.1-5.1]).
CONCLUSIONS: No association was found between the light to moderate reduction of the GFR (30 - 60 mL/min) and the development of bleeding during prophylaxis with LMWHs.


KEY WORDS: Enoxaparin - Hemorrhage - Kidney diseases - Heparin, low-molecular-weight - Venous thrombosis

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