Titre
Low-molecular-weight or unfractionated heparin in venous thromboembolism: the influence of renal function.
Type
article
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Périodique
Auteur(s)
Trujillo-Santos, J.
Auteure/Auteur
Schellong, S.
Auteure/Auteur
Falga, C.
Auteure/Auteur
Zorrilla, V.
Auteure/Auteur
Gallego, P.
Auteure/Auteur
Barrón, M.
Auteure/Auteur
Monreal, M.
Auteure/Auteur
Contributrices/contributeurs
Arcelus, JI.
Ballaz, A.
Barba, R.
Barragán, JM.
Barrón, M.
Barrón-Andrés, B.
Bascuñana, J.
Blanco-Molina, A.
Bosco, J.
Cañas, I.
Casado, I.
Conget, F.
Chaves, E.
de Miguel, J.
del Campo, R.
del Molino, F.
del Toro, J.
Falgá, C.
Fernández, M.
Fernández-Capitán, C.
Fuentes, L.
Gabriel, F.
Gallego, P.
García-Bragado, F.
Gómez, V.
González, J.
Guil, M.
Gutiérrez, J.
Hernández, L.
Hernández, HD.
Jaras, MJ.
Jiménez, D.
Jiménez, S.
Lobo, JL.
López-Jiménez, L.
Lorenzo, A.
Macià, M.
Madridano, O.
Marchena, PJ.
Martín, M.
Martín-Villasclaras, JJ.
Monreal, M.
Morales, M.
Nauffal, MD.
Nieto, JA.
Núñez, MJ.
Ogea, JL.
Otero, R.
Pedrajas, JM.
Riera-Mestre, A.
Román, P.
Rodríguez, EM.
Román-Bernal, B.
Royo, C.
Ruiz-Martínez, C.
Ruíz, J.
Ruiz-Gamietea, A.
Ruiz-Giménez, N.
Sahuquillo, JC.
Sánchez, R.
Sánchez Muñoz-Torrero JF.,
Soler, S.
Soto, MJ.
Tiberio, G.
Tolosa, C.
Trujillo, J.
Uresandi, F.
Valdés, M.
Valle, R.
Vela, J.
Vidal, G.
Villalta, J.
Zorrilla, V.
Barillari, G.
Ciammaichella, M.
Di Micco, P.
Dalla Valle, F.
Duce, R.
Maida, R.
Orlandini, F.
Pasca, S.
Piovella, C.
Poggio, R.
Prandoni, P.
Quintavalla, R.
Rota, L.
Schenone, A.
Tiraferri, E.
Tonello, D.
Visonà, A.
Zalunardo, B.
Bertoletti, L.
Bura-Riviere, A.
Debourdeau, P.
Farge-Bancel, D.
Lamuraglia, M.
Mahe, I.
Quere, I.
Brenner, B.
Alatri, A.
Bounameaux, H.
Calanca, L.
Mazzolai, L.
Malý, R.
Hirmerova, J.
Tomko, T.
Schellong, S.
Papadakis, M.
Bosevski, M.
Salgado, E.
La Regina, M.
Rodríguez-Dávila, MA.
Groupes de travail
RIETE Investigators
Liens vers les personnes
Liens vers les unités
ISSN
1555-7162
Statut éditorial
Publié
Date de publication
2013
Volume
126
Numéro
5
Première page
425
Dernière page/numéro d’article
434.e1
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov'tPublication Status: ppublish. A. Aalatri fait partie de RIETE Investigators.
Résumé
BACKGROUND: In patients with acute venous thromboembolism and renal insufficiency, initial therapy with unfractionated heparin may have some advantages over low-molecular-weight heparin.
METHODS: We used the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) Registry data to evaluate the 15-day outcome in 38,531 recruited patients. We used propensity score matching to compare patients treated with unfractionated heparin with those treated with low-molecular-weight heparin in 3 groups stratified by creatinine clearance levels at baseline: >60 mL/min, 30 to 60 mL/min, or <30 mL/min.
RESULTS: Patients initially receiving unfractionated heparin therapy (n = 2167) more likely had underlying diseases than those receiving low-molecular-weight heparin (n = 34,665). Propensity score-matched groups of patients with creatinine clearance levels >60 mL/min (n = 1598 matched pairs), 30 to 60 mL/min (n = 277 matched pairs), and <30 mL/min (n = 210 matched pairs) showed an increased 15-day mortality for unfractionated heparin compared with low-molecular-weight heparin (4.5% vs 2.4% [P = .001], 5.4% vs 5.8% [P = not significant], and 15% vs 8.1% [P = .02], respectively), an increased rate of fatal pulmonary embolism (2.8% vs 1.2% [P = .001], 3.2% vs 2.5% [P = not significant], and 5.7% vs 2.4% [P = .02], respectively), and a similar rate of fatal bleeding (0.3% vs 0.3%, 0.7% vs 0.7%, and 0.5% vs 0.0%, respectively). Multivariate analysis confirmed that patients treated with unfractionated heparin were at increased risk for all-cause death (odds ratio, 1.8; 95% confidence interval, 1.3-2.4) and fatal pulmonary embolism (odds ratio, 2.3; 95% confidence interval, 1.5-3.6).
CONCLUSIONS: In comparison with low-molecular-weight heparin, initial therapy with unfractionated heparin was associated with a higher mortality and higher rate of fatal pulmonary embolism in patients with creatinine clearance levels >60 mL/min or <30 mL/min, but not in those with levels between 30 and 60 mL/min.
METHODS: We used the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) Registry data to evaluate the 15-day outcome in 38,531 recruited patients. We used propensity score matching to compare patients treated with unfractionated heparin with those treated with low-molecular-weight heparin in 3 groups stratified by creatinine clearance levels at baseline: >60 mL/min, 30 to 60 mL/min, or <30 mL/min.
RESULTS: Patients initially receiving unfractionated heparin therapy (n = 2167) more likely had underlying diseases than those receiving low-molecular-weight heparin (n = 34,665). Propensity score-matched groups of patients with creatinine clearance levels >60 mL/min (n = 1598 matched pairs), 30 to 60 mL/min (n = 277 matched pairs), and <30 mL/min (n = 210 matched pairs) showed an increased 15-day mortality for unfractionated heparin compared with low-molecular-weight heparin (4.5% vs 2.4% [P = .001], 5.4% vs 5.8% [P = not significant], and 15% vs 8.1% [P = .02], respectively), an increased rate of fatal pulmonary embolism (2.8% vs 1.2% [P = .001], 3.2% vs 2.5% [P = not significant], and 5.7% vs 2.4% [P = .02], respectively), and a similar rate of fatal bleeding (0.3% vs 0.3%, 0.7% vs 0.7%, and 0.5% vs 0.0%, respectively). Multivariate analysis confirmed that patients treated with unfractionated heparin were at increased risk for all-cause death (odds ratio, 1.8; 95% confidence interval, 1.3-2.4) and fatal pulmonary embolism (odds ratio, 2.3; 95% confidence interval, 1.5-3.6).
CONCLUSIONS: In comparison with low-molecular-weight heparin, initial therapy with unfractionated heparin was associated with a higher mortality and higher rate of fatal pulmonary embolism in patients with creatinine clearance levels >60 mL/min or <30 mL/min, but not in those with levels between 30 and 60 mL/min.
Sujets
PID Serval
serval:BIB_BABD967F0F5B
PMID
Date de création
2014-02-11T15:18:32.135Z
Date de création dans IRIS
2025-05-21T04:27:22Z