LMWHs dosage and outcomes in acute pulmonary embolism with renal insufficiency, an analysis from a large real-world study

Dingyi Wang, Guohui Fan, Jieping Lei, Yuanhua Yang, Xiaomao Xu, Yingqun Ji, Qun Yi, Hong Chen, Xiaoyun Hu, Zhihong Liu, Yimin Mao, Jie Zhang, Juhong Shi, Zhu Zhang, Sinan Wu, Xincao Tao, Wanmu Xie, Jun Wan, Yunxia Zhang, Shuai Zhang, Kaiyuan Zhen, Zhonghe Zhang, Baomin Fang, Chen Wang, Zhenguo Zhai, China pUlmonary thromboembolism REgistry Study (CURES) investigators, Dingyi Wang, Guohui Fan, Jieping Lei, Yuanhua Yang, Xiaomao Xu, Yingqun Ji, Qun Yi, Hong Chen, Xiaoyun Hu, Zhihong Liu, Yimin Mao, Jie Zhang, Juhong Shi, Zhu Zhang, Sinan Wu, Xincao Tao, Wanmu Xie, Jun Wan, Yunxia Zhang, Shuai Zhang, Kaiyuan Zhen, Zhonghe Zhang, Baomin Fang, Chen Wang, Zhenguo Zhai, China pUlmonary thromboembolism REgistry Study (CURES) investigators

Abstract

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 .

Keywords: Acute pulmonary embolism; Adjusted dosage; Low molecular weight heparin; Prognoses; Renal insufficiency.

Conflict of interest statement

The authors declare that they have no conflict of interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flowchart. Abbreviations: APE, acute pulmonary embolism; CCr, creatinine clearance
Fig. 2
Fig. 2
Anticoagulants application [Panel A] and LMWH dose distribution [Panel B] among PE patients with renal insufficiency. Abbreviations: CCr, creatinine clearance; DOACS, direct oral anticoagulants; PE, pulmonary embolism; LMWH, low molecular weight heparin; UFH, unfractured heparin
Fig. 3
Fig. 3
Rates of in-hospital outcomes of renal insufficient patients undertaken conventional and adjusted dose of LMWH. Note. LMWH, low molecular weight heparin. * p < 0.05

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Source: PubMed

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