Abstract | INTRODUCTION: There is concern about excessive bleeding when low-molecular-weight heparins (LMWHs) are used for venous thromboembolism (VTE) prophylaxis in renal dysfunction. Our objective was to evaluate whether LMWH VTE prophylaxis was safe and effective in critically ill patients with renal dysfunction by conducting a subgroup analysis of PROTECT, a randomized blinded trial. METHODS: RESULTS: In patients with ESRD, there was no significant difference in DVT (8.3% vs. 5.2%, p = 0.76), any VTE (10.0% vs. 6.9%; p = 0.39) or major bleeding (5.0% vs. 8.6%; p = 0.32) between UFH and dalteparin. In patients with severe renal dysfunction, there was no significant difference in any VTE (10.0% vs. 6.4%; p = 0.07) or major bleeding (8.9% vs. 11.0%; p = 0.66) but an increase in DVT with dalteparin (7.6% vs. 3.7%; p = 0.04). Interaction p-values for comparisons of HRs ( ESRD versus not) were non-significant. CONCLUSIONS: In critically ill patients with ESRD, or severe renal dysfunction, there was no significant difference in any VTE or major bleeding between UFH and dalteparin. Patients with severe renal dysfunction who received dalteparin had more proximal DVTs than those on UFH; this finding did not hold in patients with ESRD alone.
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Authors | Menaka Pai, Neill K J Adhikari, Marlies Ostermann, Diane Heels-Ansdell, James D Douketis, Yoanna Skrobik, Ismael Qushmaq, Maureen Meade, Gordon Guyatt, William Geerts, Michael W Walsh, Mark A Crowther, Jan O Friedrich, Lisa Burry, Rinaldo Bellomo, Nilton Brandão da Silva, Rubens Costa Filho, Michael J Cox, Suzana Alves Silva, Deborah J Cook, PROTECT (Prophylaxis for Thromboembolism in Critical Care Trial) Investigators |
Journal | PloS one
(PLoS One)
Vol. 13
Issue 6
Pg. e0198285
( 2018)
ISSN: 1932-6203 [Electronic] United States |
PMID | 29856817
(Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Anticoagulants
- Heparin, Low-Molecular-Weight
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Topics |
- Adult
- Aged
- Aged, 80 and over
- Anticoagulants
(therapeutic use)
- Chemoprevention
(methods)
- Critical Care
(methods)
- Critical Illness
(therapy)
- Female
- Heparin, Low-Molecular-Weight
(therapeutic use)
- Humans
- Kidney Failure, Chronic
(drug therapy)
- Male
- Middle Aged
- Venous Thromboembolism
(prevention & control)
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