November 16, 2005Blood
Low Molecular Weight Heparin and Bleeding in Patients with Severe Renal Failure: A Meta-Analysis.
Key result
Severe renal insufficiency (CrCl ≤ 30 ml/min) significantly increased the risk of major bleeding in patients treated with low molecular weight heparin compared to CrCl > 30 ml/min (RR 2.34; 95% CI 1.46-3.74; P=0.0004).
Why the study?
Does LMWH treatment increase the risk of major bleeding in non-dialyzed patients with severe renal insufficiency (CrCl ≤ 30 ml/min) compared to those with CrCl > 30 ml/min?
Population
4,971 non-dialyzed patients treated with low molecular weight heparin from 12 studies.
Comparison
LMWH treatment in patients with severe renal… vs LMWH treatment in patients with creatinine…
Design
Meta-analysis
Authors
Discussion
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Implication
Standard LMWH dosing raises major bleeding risk in CrCl ≤30 ml/min; supports empiric adjustment and prospective trials of optimized regimens.
Study Design
Type
Meta-Analysis (n=4,971)
Multicenter
Yes
Structured PICO
Does LMWH treatment increase the risk of major bleeding in non-dialyzed patients with severe renal insufficiency (CrCl ≤ 30 ml/min) compared to those with CrCl > 30 ml/min?
P
Population
4,971 non-dialyzed patients treated with low molecular weight heparin across 12 studies, comparing those with creatinine clearance ≤ 30 ml/min to > 30 ml/min.
E
Exposure
LMWH treatment in patients with severe renal insufficiency (creatinine clearance ≤ 30 ml/min)
C
Comparator
LMWH treatment in patients with creatinine clearance > 30 ml/min
O
Outcome
Major bleedingsafety
Main Result
Relative Risk: 2.34 (95% CI 1.46–3.74)
Absolute Event Rate: 5% vs 2.4%
Number Needed to Treat: 38
p-value: p=0.0004
Therapeutic doses of enoxaparin significantly increase the risk of major bleeding in non-dialysis patients with severe renal insufficiency, supporting the need for empiric dose reduction.
Limitations
- Only 2 LMWH preparations were evaluated and only 2 studies used tinzaparin.
- Data are observational and the potential for confounding cannot be excluded.
- Only 2 LMWH preparations were evaluated
- Only 2 studies used tinzaparin
- Data are observational and the potential for confounding cannot be excluded
Cite This Study
Lim et al. (2005) conducted a meta-analysis in Severe renal failure (n=4,971). Severe renal insufficiency (CrCl ≤ 30 ml/min) vs. CrCl > 30 ml/min was evaluated on Major bleeding (RR 2.34, 95% CI 1.46-3.74, p=0.0004). Severe renal insufficiency (CrCl ≤ 30 ml/min) significantly increased the risk of major bleeding in patients treated with low molecular weight heparin compared to CrCl > 30 ml/min (RR 2.34; 95% CI 1.46-3.74; P=0.0004).