Impact of stage 3B chronic kidney disease on thrombosis and bleeding outcomes after orthopedic surgery in patients treated with desirudin or enoxaparin: insights from a randomized trial
Research article published in Journal of thrombosis and haemostasis (2012)
Abstract
BACKGROUND: Venous thromboembolism (VTE) remains a significant complication of major orthopedic surgery, and chronic kidney disease (CKD) is common among elderly patients undergoing total hip replacement (THR). OBJECTIVES: The purpose of this study was to evaluate thrombosis and bleeding outcomes in patients with stage 3B CKD treated with either desirudin or enoxaparin after elective THR. PATIENTS/METHODS: This was a post hoc subgroup analysis of a randomized, multicenter, double-blind study of desirudin vs. enoxaparin in patients undergoing elective THR. RESULTS: Patients received either subcutaneous desirudin 15 mg twice daily or subcutaneous enoxaparin 40 mg once daily. Of the 2078 randomized patients who received study medication, 577 had stage 3B CKD or worse (27.8%), and the proportion of these patients who experienced a major VTE in the enoxaparin treatment group was found to be much higher than in the desirudin treatment group (11.1% vs. 3.4%, model-adjusted odds ratio 3.52, 95% confidence interval 1.48-8.40, P=0.004). There was no statistically significant difference between treatment groups in terms of rates of major bleeding, regardless of stage of renal function. CONCLUSIONS: CKD has been reported previously to increase the risk of bleeding with anticoagulants, and these findings suggest that CKD may also increase the risk of major VTE for patients treated with enoxaparin, but not for patients treated with desirudin. Clinicians should consider the impact of CKD on the risk of VTE when choosing a prophylaxis agent.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Zusammenfassung
Impact of stage 3B chronic kidney disease on thrombosis and bleeding outcomes after orthopedic surgery in patients treated with desirudin or enoxaparin: insights from a randomized trial.
Warum dies für die Hirudotherapie relevant ist
This post hoc subgroup analysis of a randomized, multicenter, double-blind study compared subcutaneous desirudin 15 mg twice daily versus enoxaparin 40 mg once daily for VTE prophylaxis after elective total hip replacement, focusing on 577 of 2078 randomized patients with stage 3B CKD or worse. Major VTE was reported more frequently with enoxaparin than desirudin (11.1% vs 3.4%; model-adjusted OR 3.52, 95% CI 1.48–8.40, P=0.004), with no statistically significant difference in major bleeding regardless of renal function. The authors conclude that CKD may increase major VTE risk with enoxaparin but not desirudin, and clinicians should consider renal function when selecting prophylaxis. The abstract itself does not identify desirudin as leech-derived, hirudin-related, or otherwise tied to hirudotherapy or the leech secretome, so its direct ASH relevance cannot be asserted from the abstract alone.
Zitation
Impact of stage 3B chronic kidney disease on thrombosis and bleeding outcomes after orthopedic surgery in patients treated with desirudin or enoxaparin: insights from a randomized trial
Shorr AF et al. · Journal of thrombosis and haemostasis, 2012
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