Thrombosis Journal (May 2022)

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,
  • On behalf of the China pUlmonary thromboembolism REgistry Study (CURES) investigators

DOI
https://doi.org/10.1186/s12959-022-00385-z
Journal volume & issue
Vol. 20, no. 1
pp. 1 – 9

Abstract

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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 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 .

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