Key result
While underdosing of low-molecular-weight heparin was common and not associated with increased adverse events, severe renal insufficiency was an independent risk factor for major adverse vascular events (OR 31.93).
Why the study?
Does underdosing of LMWH increase the risk of major adverse vascular events in cardiovascular inpatients compared to recommended dosing?
Cohort (n=312)
No
Does underdosing of LMWH increase the risk of major adverse vascular events in cardiovascular inpatients compared to recommended dosing?
In cardiovascular inpatients without severe renal insufficiency, the common clinical practice of administering fixed, lower doses of LMWH was not associated with an increased risk of adverse vascular events during hospitalization.
Does not support changing LMWH dosing yet; leaves open randomized trials to confirm safety in non-severely renally impaired inpatients.
BACKGROUND: Low-molecular-weight heparins (LMWHs) are safe and effective anticoagulant options for cardiovascular patients when applied as body weight-adjusted doses. However, there are some barriers that make it difficult to implement weight-adjusted doses in clinical practice. Therefore, it is vital to learn the dosing practices of LMWH and its efficacy and safety in clinical practice. METHODS: A retrospective study was conducted in cardiovascular inpatients who had received at least one dose of LMWH during a 6-month period. Appropriateness of LMWH dosing was determined and major clinical outcomes (major adverse vascular events and major bleeding) during hospitalization were evaluated. RESULTS: A total of 376 admissions representing 364 patients received LMWH treatment. Of these, 17.0% (64/376) of admissions did not have body weight records. Of the 312 admissions included for the outcome study, only 34 cases (10.9%) received the recommended doses of LMWH, while 51 cases (16.3%) received mild underdoses, 223 cases (71.5%) received major underdoses and 4 (1.3%) received excess doses. There were 10 major adverse vascular events, which occurred more often in patients receiving excess doses of LMWH than in patients receiving recommended, mild or major underdoses (50%, 2.9%, 2.0% and 2.7%, respectively, P < 0.001). After multivariable analysis, severe renal insufficiency was an independent risk factor for major adverse vascular events [odds ratio (OR), 31.93; 95% confidence interval (CI), 5.99-170.30; P < 0.001]. No major bleeding was recorded. CONCLUSIONS: Underdose of LMWH is commonly used in cardiovascular inpatients, which was suboptimal according to guidelines. Using LMWH at a fixed, low dose for treatment purposes in patients without severe renal insufficiency was not associated with a higher risk of adverse vascular events in the current study, though larger studies with extended follow-ups are required to fully assess the long-term consequences of LMWH underdosing.
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Xu et al. (2012) conducted a cohort in Cardiovascular diseases requiring anticoagulation (n=312). Severe renal insufficiency vs. Patients without severe renal insufficiency was evaluated on Major adverse vascular events (OR 31.93, 95% CI 5.99-170.30, p=<0.001). While underdosing of low-molecular-weight heparin was common and not associated with increased adverse events, severe renal insufficiency was an independent risk factor for major adverse vascular events (OR 31.93).
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