Initiative to improve thromboprophylactic enoxaparin exposure in hospitalized patients with renal impairment

American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists
Khaled A Elsaid, Christine M Collins

Abstract

The impact of a quality-improvement (QI) initiative to decrease the risk of bleeding in renally impaired patients receiving enoxaparin prophylaxis for venous thromboembolism (VTE) was evaluated. A retrospective cohort with a before-and-after study design was employed. Inclusion criteria included age over 40 years, hospitalization exceeding six days, treatment with enoxaparin or unfractionated heparin (UFH), and acute or chronic renal insufficiency. Major bleeding included fatal bleeding, symptomatic bleeding requiring hemodynamic support or causing a decrease of 2 g/dL or more in hemoglobin concentration, or bleeding leading to the transfusion of at least 2 units of packed red blood cells. The QI intervention restricted enoxaparin use in patients with a creatinine clearance (CL(cr)) concentration of <30 mL/min and recommended UFH instead. The rate of major bleeding in the preintervention group was 13.5% with enoxaparin compared with 4.1% with UFH (p = 0.005). The relative risk (RR) of bleeding with enoxaparin compared with UFH was 3.21 (95% confidence interval [CI], 1.40-7.34). In patients with a CL(cr) concentration of <30 mL/min, the RR of bleeding with enoxaparin compared with UFH was 4.68 (95% CI, 1.06-20.59). The rate of m...Continue Reading

References

Jan 27, 2004·The Annals of Pharmacotherapy·Jennifer E Stark, Wanda J Kilzer
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Apr 21, 2011·Thrombosis and Haemostasis·R BauersachsH Riess

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Citations

Jun 14, 2013·Journal of Hospital Medicine : an Official Publication of the Society of Hospital Medicine·Sosena KebedeJodi B Segal
Sep 28, 2018·The Journal of International Medical Research·Lamis R KaraouiNibal Chamoun

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