ORIGINAL ARTICLE

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

  1. A. F. SHORR1,
  2. B. I. ERIKSSON2,
  3. A. K. JAFFER3,
  4. J. SMITH4

Article first published online: 14 AUG 2012

DOI: 10.1111/j.1538-7836.2012.04803.x

Issue

Journal of Thrombosis and Haemostasis

Journal of Thrombosis and Haemostasis

Volume 10, Issue 8, pages 1515–1520, August 2012

Additional Information

How to Cite

SHORR, A. F., ERIKSSON, B. I., JAFFER, A. K. and SMITH, J. (2012), 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. Journal of Thrombosis and Haemostasis, 10: 1515–1520. doi: 10.1111/j.1538-7836.2012.04803.x

Author Information

  1. 1

    Pulmonary and Critical Care Medicine, Washington Hospital Center, Washington, DC, USA

  2. 2

    Department of Orthopedics, Institute of Surgical Sciences, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden

  3. 3

    Department of Medicine, Hospital Medicine, University of Miami Miller School of Medicine, Miami, FL

  4. 4

    Biostatistics, Adaptive Plus, LLC, Durham, NC, USA

*Andrew F. Shorr, Pulmonary and Critical Care Medicine, Washington Hospital Center, 110 Irving St, NW 20010, Washington, DC, USA. Tel.: +1 2028777856; fax: +1 2022910386. E-mail: andrew.shorr@gmail.com

Publication History

  1. Issue published online: 14 AUG 2012
  2. Article first published online: 14 AUG 2012
  3. Accepted manuscript online: 4 JUN 2012 11:54AM EST
  4. Received 1 February 2012, accepted 29 May 2012

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Keywords:

  • chronic kidney disease;
  • deep vein thrombosis;
  • desirudin;
  • enoxaparin;
  • hirudin;
  • randomized controlled trial;
  • renal impairment

Summary.  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.

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