We also conducted an additional bleeding analysis in which patients naturally fell out of the study once a DVT/PE occurred in order to prevent us from counting any excess bleeding events that occurred after a thrombosis event ( Supplementary Appendix B).Enoxaparin is available as an injectable medicine that helps prevent blood clots in the legs and other parts of the body. As part of a sensitivity analysis, the outcomes were also recalculated using a 90- and 150-day follow-up period ( Supplementary Appendix B).

The secondary end point was DVT or PE that resulted in hospitalization or death within 120 days of enoxaparin or heparin treatment. The definition of bleeding included hemorrhagic stroke, gastrointestinal bleeding, postprocedure bleeding, gynecological bleeding, hemorrhage into the abdominal cavity, hemorrhage into the pulmonary cavity, bleeding secondary to a coagulopathy, vascular access bleeding, hematoma, or other (epistaxis, orbital, unspecified bleeding). The primary end point of the study was bleeding that resulted in hospitalization or death within 120 days since enoxaparin or heparin treatment was started. Risk-adjusted event rate (per 100 pt yrs) Table 3 Bleeding rate by prophylaxis regime, stratified by risk factor Risk factor for bleeding The HR was 0.96 (95% CI 0.68–1.35) for bleeding with standard-dose enoxaparin for non-CKD patients and it was 0.89 (95% CI 0.64–1.25) for bleeding with renal dose enoxaparin when compared with heparin. These conclusions also remained the same with Cox regression, where the enoxaparin dose was modeled as a time-varying covariate. The RR for standard-dose enoxaparin was 1.02 (95% CI 0.76–1.38). In comparison with heparin, the RR for bleeding with low-dose enoxaparin was 0.95 (95% CI 0.71–1.28). These bleeding rates were not statistically different ( P=0.71) from each other, nor was the cumulative dose of enoxaparin different in patients who had a bleeding event versus those who did not (5499 vs. In dose–response analyses, patients administered standard-dose enoxaparin for normal renal function (31–60 mg per day, n=1422) had a standardized bleeding rate of 17.6 events per 100 patient-years (12.6–24.4), whereas patients with a dose reduction for moderate CKD (30 mg per day, n=1569) had a standardized bleeding rate of 16.3 events per 100 patient-years (11.7–22.8). Thus, in dialysis patients, daily enoxaparin for thromboprophylaxis was not associated with increased serious bleeding or less effective compared to subcutaneous heparin. The risk of venous thromboembolism was not associatively worse with enoxaparin (risk ratio, 0.77 95% CI 0.49–1.22).

In risk factor–adjusted Poisson models, enoxaparin was not associated with more bleeding in comparison to heparin (risk ratio, 0.98 95% CI 0.78–1.23). Among 7721 dialysis patients started on subcutaneous enoxaparin or heparin at doses for thromboprophylaxis, the crude rate for bleeding requiring hospitalization or resulting in death was 15.2 (95% confidence interval (CI) 12.7–18.2) events per 100 patient-years in the enoxaparin group, which did not differ from the heparin group in which the crude rate was 16.2 (95% CI 14.0–18.7) events per 100 patient-years. The primary study end point was hospitalization or death related to bleeding, with a secondary end point of venous thromboembolism. Here we conducted a retrospective comparative effectiveness study in a large population of chronic maintenance dialysis patients initiated with subcutaneous injections of enoxaparin or heparin for thromboprophylaxis. Accordingly, it is unknown if enoxaparin is as safe to prescribe as subcutaneous heparin for thromboprophylaxis in patients with chronic renal failure. Enoxaparin, a low-molecular-weight form of heparin, is not approved for use in dialysis patients in the United States, because it is eliminated through the kidneys and could therefore accumulate and cause inadvertent bleeding.

Enoxaparin antidote