Major bleeding risks of different low‐molecular‐weight heparin agents: a cohort study in 12 934 patients treated for acute venous thrombosis

Abstract

Background Low-molecular-weight heparins (LMWHs) are considered members of a class of drugs with similar anticoagulant properties. However, pharmacodynamics and pharmacokinetics between LMWHs differ, which may result in different bleeding risks. As these agents are used by many patients, small differences may lead to a large effect on numbers of major bleeding events. Objectives To determine major bleeding risks for different LMWH agents and dosing schedules. Methods A cohort of acute venous thrombosis patients from four anticoagulation clinics who used an LMWH and a vitamin K antagonist were followed until they ceased LMWH treatment or until major bleeding. Exposures were classified according to different types of LMWHs and for b.i.d. and o.d. use. Cumulative incidences for major bleeding per 1000 patients and risk ratios were calculated and adjusted for study center. Results The study comprised 12 934 patients with a mean age of 59 years; 6218 (48%) were men. The cumulative incidence of major bleeding was 2.5 per 1000 patients (95% confidence interval [CI], 1.7-3.5). Enoxaparin b.i.d. or o.d. was associated with a relative bleeding risk of 1.7 (95% CI, 0.2-17.5) compared with nadroparin o.d. In addition, a nadroparin b.i.d. dosing schedule was associated with a 2.0-fold increased major bleeding risk (95% CI, 0.8-5.1) as compared with a nadroparin o.d. dosing schedule. Conclusions Absolute major bleeding rates were low for all LMWH agents and dosing schedules in a large unselected cohort. Nevertheless, twice-daily dosing with nadroparin appeared to be associated with an increased major bleeding risk as compared with once-daily dosing, as also suggested in a meta-analysis of controlled clinical trials.

Alternative physical treatments for deep venous thrombosis prophylaxis in surgical patients: a systematic review

“…Early mobilisation may not be possible for patients unable to transfer to a chair, or weightbear as a result of their condition. Although LMWH has a more predictable effect than unfractionated heparin, it can still lead to an increased risk of surgical site bleeding [28] and is contraindicated in patients at high risk of bleeding [29]. Similarly, graduated compression stockings cannot always be used following recent surgery to the lower extremity, limiting their applicability following foot and ankle surgery and lower limb reconstruction.…”

Mussel-Inspired Antimicrobial and Antifouling Coating Constructed by the Combination of Zwitterionic Copolymers and Silver Nanoparticles

“…], the surfaces of these biomedical devices are prone to non-specific protein adsorption, platelet adhesion/activation, and bacterial colonization, leading to thrombus and biofilm formation, which ultimately result in device failure. − Current clinical approaches for addressing these issues often involve the administration of anticoagulants and antibiotic-based pharmaceutical therapy. However, the overuse and abuse of such drugs may result in inevitable damage to the human body and even trigger drug resistance. − Therefore, it is clinically significant to propose a new strategy to endow implant materials with effective antifouling and antibacterial properties to ensure their safe and long-term application.…”

Use of Evodial Dializers for Hemodialysis in Patients With High Risk for Bleeding - Single Centre Experience

“…Hence, some form of anticoagulation is used to prevent this coagulation propensity within the circuit. The most efficient and studied anticoagulant is heparin, either unfractionated or fractionated (low molecular weight heparin -LMWH) [5,6].…”