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LMWHs dosage and outcomes in acute pulmonary embolism with renal insufficiency, an analysis from a large real-world study
BACKGROUND: Renal function is associated with prognoses for acute pulmonary embolism (PE). OBJECTIVE: To investigate the application of anticoagulants and dosage of LMWH among patients with renal insufficiency (RI), and the association between LWMH dosage and the patients’ in-hospital outcomes. METH...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9074331/ https://www.ncbi.nlm.nih.gov/pubmed/35513826 http://dx.doi.org/10.1186/s12959-022-00385-z |
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author | Wang, Dingyi Fan, Guohui Lei, Jieping Yang, Yuanhua Xu, Xiaomao Ji, Yingqun Yi, Qun Chen, Hong Hu, Xiaoyun Liu, Zhihong Mao, Yimin Zhang, Jie Shi, Juhong Zhang, Zhu Wu, Sinan Tao, Xincao Xie, Wanmu Wan, Jun Zhang, Yunxia Zhang, Shuai Zhen, Kaiyuan Zhang, Zhonghe Fang, Baomin Wang, Chen Zhai, Zhenguo |
author_facet | Wang, Dingyi Fan, Guohui Lei, Jieping Yang, Yuanhua Xu, Xiaomao Ji, Yingqun Yi, Qun Chen, Hong Hu, Xiaoyun Liu, Zhihong Mao, Yimin Zhang, Jie Shi, Juhong Zhang, Zhu Wu, Sinan Tao, Xincao Xie, Wanmu Wan, Jun Zhang, Yunxia Zhang, Shuai Zhen, Kaiyuan Zhang, Zhonghe Fang, Baomin Wang, Chen Zhai, Zhenguo |
author_sort | Wang, Dingyi |
collection | PubMed |
description | BACKGROUND: Renal function is associated with prognoses for acute pulmonary embolism (PE). OBJECTIVE: To investigate the application of anticoagulants and dosage of LMWH among patients with renal insufficiency (RI), and the association between LWMH dosage and the patients’ in-hospital outcomes. METHODS: Adult patients diagnosed with non-high risk acute PE from 2009 to 2015, with available data of creatinine clearance (CCr) were enrolled from a multicenter registry in China. Renal insufficiency (RI) was defined as CCr < 60 ml/min. LMWH dosage was converted into IU/kg daily dose and presented as adjusted dose (≤ 100 IU/kg/day) and conventional dose (> 100 IU/kg/day). All-cause death, PE-related death and bleeding events during hospitalization were analyzed as endpoints. RESULTS: Among the enrolled 5870 patients, RI occurred in 1311 (22.3%). 30 ≤ CCr < 60 ml/min was associated with higher rate of bleeding events and CCr < 30 ml/min was associated with all-cause death, PE-related death and major bleeding. Adjusted-dose LMWH was applied in 26.1% of patients with 30 ≤ CCr < 60 ml/min and in 26.2% of CCr < 30 ml/min patients. Among patients with RI, in-hospital bleeding occurred more frequently in those who were administered conventional dose of LMWH, compared with adjusted dose (9.2% vs 5.0%, p = 0.047). Adjusted dose of LMWH presented as protective factor for in-hospital bleeding (OR 0.62, 95%CI 0.27–1.00, p = 0.0496) and the risk of bleeding increased as length of hospital stay prolonged (OR 1.03, 95%CI 1.01–1.06, p = 0.0014). CONCLUSIONS: The proportion of adjusted usage of LMWH was low. The application of adjusted-dose LMWH was associated with lower risk of in-hospital bleeding for RI patients, in real-world setting of PE treatment. Anticoagulation strategy for RI patients should be paid more attention and requires evidence of high quality. TRIAL REGISTRATION: The CURES was registered in ClinicalTrias.gov, identifier number: NCT02943343. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12959-022-00385-z. |
format | Online Article Text |
id | pubmed-9074331 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-90743312022-05-07 LMWHs dosage and outcomes in acute pulmonary embolism with renal insufficiency, an analysis from a large real-world study Wang, Dingyi Fan, Guohui Lei, Jieping Yang, Yuanhua Xu, Xiaomao Ji, Yingqun Yi, Qun Chen, Hong Hu, Xiaoyun Liu, Zhihong Mao, Yimin Zhang, Jie Shi, Juhong Zhang, Zhu Wu, Sinan Tao, Xincao Xie, Wanmu Wan, Jun Zhang, Yunxia Zhang, Shuai Zhen, Kaiyuan Zhang, Zhonghe Fang, Baomin Wang, Chen Zhai, Zhenguo Thromb J Research BACKGROUND: Renal function is associated with prognoses for acute pulmonary embolism (PE). OBJECTIVE: To investigate the application of anticoagulants and dosage of LMWH among patients with renal insufficiency (RI), and the association between LWMH dosage and the patients’ in-hospital outcomes. METHODS: Adult patients diagnosed with non-high risk acute PE from 2009 to 2015, with available data of creatinine clearance (CCr) were enrolled from a multicenter registry in China. Renal insufficiency (RI) was defined as CCr < 60 ml/min. LMWH dosage was converted into IU/kg daily dose and presented as adjusted dose (≤ 100 IU/kg/day) and conventional dose (> 100 IU/kg/day). All-cause death, PE-related death and bleeding events during hospitalization were analyzed as endpoints. RESULTS: Among the enrolled 5870 patients, RI occurred in 1311 (22.3%). 30 ≤ CCr < 60 ml/min was associated with higher rate of bleeding events and CCr < 30 ml/min was associated with all-cause death, PE-related death and major bleeding. Adjusted-dose LMWH was applied in 26.1% of patients with 30 ≤ CCr < 60 ml/min and in 26.2% of CCr < 30 ml/min patients. Among patients with RI, in-hospital bleeding occurred more frequently in those who were administered conventional dose of LMWH, compared with adjusted dose (9.2% vs 5.0%, p = 0.047). Adjusted dose of LMWH presented as protective factor for in-hospital bleeding (OR 0.62, 95%CI 0.27–1.00, p = 0.0496) and the risk of bleeding increased as length of hospital stay prolonged (OR 1.03, 95%CI 1.01–1.06, p = 0.0014). CONCLUSIONS: The proportion of adjusted usage of LMWH was low. The application of adjusted-dose LMWH was associated with lower risk of in-hospital bleeding for RI patients, in real-world setting of PE treatment. Anticoagulation strategy for RI patients should be paid more attention and requires evidence of high quality. TRIAL REGISTRATION: The CURES was registered in ClinicalTrias.gov, identifier number: NCT02943343. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12959-022-00385-z. BioMed Central 2022-05-05 /pmc/articles/PMC9074331/ /pubmed/35513826 http://dx.doi.org/10.1186/s12959-022-00385-z Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Wang, Dingyi Fan, Guohui Lei, Jieping Yang, Yuanhua Xu, Xiaomao Ji, Yingqun Yi, Qun Chen, Hong Hu, Xiaoyun Liu, Zhihong Mao, Yimin Zhang, Jie Shi, Juhong Zhang, Zhu Wu, Sinan Tao, Xincao Xie, Wanmu Wan, Jun Zhang, Yunxia Zhang, Shuai Zhen, Kaiyuan Zhang, Zhonghe Fang, Baomin Wang, Chen Zhai, Zhenguo LMWHs dosage and outcomes in acute pulmonary embolism with renal insufficiency, an analysis from a large real-world study |
title | LMWHs dosage and outcomes in acute pulmonary embolism with renal insufficiency, an analysis from a large real-world study |
title_full | LMWHs dosage and outcomes in acute pulmonary embolism with renal insufficiency, an analysis from a large real-world study |
title_fullStr | LMWHs dosage and outcomes in acute pulmonary embolism with renal insufficiency, an analysis from a large real-world study |
title_full_unstemmed | LMWHs dosage and outcomes in acute pulmonary embolism with renal insufficiency, an analysis from a large real-world study |
title_short | LMWHs dosage and outcomes in acute pulmonary embolism with renal insufficiency, an analysis from a large real-world study |
title_sort | lmwhs dosage and outcomes in acute pulmonary embolism with renal insufficiency, an analysis from a large real-world study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9074331/ https://www.ncbi.nlm.nih.gov/pubmed/35513826 http://dx.doi.org/10.1186/s12959-022-00385-z |
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