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.
Resumen
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.
Por qué esto importa para la hirudoterapia
Este análisis post hoc de subgrupos de un estudio aleatorizado, multicéntrico y doble ciego comparó desirudina subcutánea 15 mg dos veces al día frente a enoxaparin 40 mg una vez al día para la profilaxis de TEV tras artroplastia total de cadera electiva, centrándose en 577 de 2078 pacientes aleatorizados con ERC en estadio 3B o peor. La TEV mayor se notificó con mayor frecuencia con enoxaparin que con desirudina (11,1% vs 3,4%; OR ajustada por modelo 3,52; IC 95% 1,48–8,40; P=0,004), sin diferencias estadísticamente significativas en hemorragia mayor independientemente de la función renal. Los autores concluyen que la ERC puede aumentar el riesgo de TEV mayor con enoxaparin pero no con desirudina, y que los clínicos deben considerar la función renal al seleccionar la profilaxis. El propio resumen no identifica a la desirudina como derivada de sanguijuela, relacionada con la hirudina ni vinculada de otro modo a la hirudoterapia o al secretoma de la sanguijuela, por lo que su relevancia directa para la ASH no puede afirmarse a partir del resumen.
Citación
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
Contexto clínico relacionado
Explore cómo esta investigación se conecta con la práctica clínica
Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026