Korean J Nephrol.  2011 Mar;30(2):155-162.

Bleeding Complications Associated With the Use of Low Molecular Weight Heparin According to the Degree of Renal Impairment

• Song EJ
• Lee SY
• Jung YM
• Nho KW
• Sung SA
• Hwang YH
• Lee SY

Abstract

PURPOSE
Low molecular weight heparin (LMWH) is safe and effective in the treatment of acute coronary syndrome (ACS) and venous thromboembolism. Compared with unfractionated heparin (UFH), it is known to have less bleeding tendency in the general population. However, it is not certain whether bleeding complications are decreased by LMWH in patients with renal failure. We postulated that the use of LMWH may lead to increase in bleeding tendency in patients with renal dysfunction.
METHODS
We conducted a retrospective study in 486 hospitalized patients who were diagnosed as cerebral infarction or ACS, and treated with enoxaparin or nadroparin from January 2008 to December 2009. Bleeding complications were compared in 3 groups according to estimated glomerular filtration rate (GFR> or =60, 30-59, and <30 mL/min/1.73m2). Age, hypertension (HTN), diabetes mellitus (DM), smoking and usage of antithrombotics were examined and the relationship of these variables with bleeding tendency was analyzed.
RESULTS
Compared with group I, the frequency of total bleeding complications increased in patients with group II (p=0.002) and III (p=0.005) regardless of adequate dose reduction. Multiple logistic regression analysis after adjustment for age, HTN, DM, and usage of antithrombotics revealed that decreased GFR groups [odds ratio (OR) of group II was 5.79 (95% confidence interval (CI), 1.23-29.97; p=0.042), OR of group III 5.92 (95% CI, 1.22-27.61; p=0.029)] and DM [OR of DM 7.88 (95% CI; 1.46-46.32, p=0.026)] were two independent factors which affect major bleeding.
CONCLUSION
These findings suggest that renal insufficiency, even if it is mild, could affect major bleeding complications in the use of LMWH.

Keyword

Low molecular weight heparin; Bleeding; Renal insufficiency

MeSH Terms

Acute Coronary Syndrome
Cerebral Infarction
Diabetes Mellitus
Enoxaparin
Glomerular Filtration Rate
Hemorrhage
Heparin
Heparin, Low-Molecular-Weight
Humans
Hypertension
Logistic Models
Nadroparin
Renal Insufficiency
Retrospective Studies
Smoke
Smoking
Venous Thromboembolism
Enoxaparin
Heparin
Heparin, Low-Molecular-Weight
Nadroparin
Smoke