Low-molecular-weight or unfractionated heparin in venous thromboembolism: the influence of renal function.
Data(s) |
2013
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Resumo |
BACKGROUND: In patients with acute venous thromboembolism and renal insufficiency, initial therapy with unfractionated heparin may have some advantages over low-molecular-weight heparin. METHODS: We used the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) Registry data to evaluate the 15-day outcome in 38,531 recruited patients. We used propensity score matching to compare patients treated with unfractionated heparin with those treated with low-molecular-weight heparin in 3 groups stratified by creatinine clearance levels at baseline: >60 mL/min, 30 to 60 mL/min, or <30 mL/min. RESULTS: Patients initially receiving unfractionated heparin therapy (n = 2167) more likely had underlying diseases than those receiving low-molecular-weight heparin (n = 34,665). Propensity score-matched groups of patients with creatinine clearance levels >60 mL/min (n = 1598 matched pairs), 30 to 60 mL/min (n = 277 matched pairs), and <30 mL/min (n = 210 matched pairs) showed an increased 15-day mortality for unfractionated heparin compared with low-molecular-weight heparin (4.5% vs 2.4% [P = .001], 5.4% vs 5.8% [P = not significant], and 15% vs 8.1% [P = .02], respectively), an increased rate of fatal pulmonary embolism (2.8% vs 1.2% [P = .001], 3.2% vs 2.5% [P = not significant], and 5.7% vs 2.4% [P = .02], respectively), and a similar rate of fatal bleeding (0.3% vs 0.3%, 0.7% vs 0.7%, and 0.5% vs 0.0%, respectively). Multivariate analysis confirmed that patients treated with unfractionated heparin were at increased risk for all-cause death (odds ratio, 1.8; 95% confidence interval, 1.3-2.4) and fatal pulmonary embolism (odds ratio, 2.3; 95% confidence interval, 1.5-3.6). CONCLUSIONS: In comparison with low-molecular-weight heparin, initial therapy with unfractionated heparin was associated with a higher mortality and higher rate of fatal pulmonary embolism in patients with creatinine clearance levels >60 mL/min or <30 mL/min, but not in those with levels between 30 and 60 mL/min. |
Identificador |
http://serval.unil.ch/?id=serval:BIB_BABD967F0F5B isbn:1555-7162 (Electronic) pmid:23499331 doi:10.1016/j.amjmed.2012.09.021 isiid:000317338100023 |
Idioma(s) |
en |
Fonte |
American Journal of Medicine, vol. 126, no. 5, pp. 425-434.e1 |
Palavras-Chave | #Adult; Aged; Female; Follow-Up Studies; Heparin/adverse effects; Heparin/therapeutic use; Heparin, Low-Molecular-Weight/adverse effects; Heparin, Low-Molecular-Weight/therapeutic use; Humans; Kidney/drug effects; Kidney/physiopathology; Kidney Function Tests; Male; Middle Aged; Renal Insufficiency/complications; Renal Insufficiency/drug therapy; Treatment Outcome; Venous Thromboembolism/complications; Venous Thromboembolism/drug therapy |
Tipo |
info:eu-repo/semantics/article article |