http://archinte.jamanetwork.com/ en-us Wed, 12 Dec 2012 00:00:00 GMT Tue, 01 Jan 2013 00:51:42 GMT Silverchair editor@archinte.jamanetwork.com webmaster@archinte.jamanetwork.com http://archinte.jamanetwork.com/article.aspx?articleID=1389241 Mon, 10 Dec 2012 00:00:00 GMT DeCarolis DD, Thorson JG, Clairmont MA, et al. <span class="paragraphSection"><div class="boxTitle">Background</div>Enoxaparin sodium has predictable pharmacokinetics that allow for simplified dosing without laboratory monitoring. Reliance on renal function for excretion may lead to accumulation of enoxaparin in patients with moderate renal impairment. However, there is no dose adjustment recommended for these patients. We conducted a review to compare bleeding events in patients with moderate renal impairment compared with those with normal renal function.<div class="boxTitle">Methods</div>Patients received enoxaparin sodium, 1 mg/kg, every 12 hours or 1.5 mg/kg once daily between June 1 and November 30, 2009. Moderate renal impairment was defined as creatinine clearance (CrCl) of 30 to 50 mL/min. Normal renal function was defined as CrCl greater than 80 mL/min. The primary outcome was major bleeding, defined as any bleeding resulting in death, hospital admission, lengthened hospital stay, or an emergency department visit. The secondary outcome was thromboembolism.<div class="boxTitle">Results</div>A total of 164 patients met the inclusion criteria: 105 with normal renal function and 59 with moderate renal impairment. The primary outcome occurred in 6 of 105 patients (5.7%) with normal renal function vs 13 of 59 patients (22.0%) with moderate renal impairment, representing an unadjusted odds ratio of 4.7 (95% CI, 1.7-13.0; P = .002). The odds ratio using multivariable logistic regression adjusting for differences in risk was 3.9 (95% CI, 0.97-15.6; P = .055). There was no recurrent thromboembolism in either group.<div class="boxTitle">Conclusions</div>Our results suggest an increased risk of major bleeding in patients with moderate renal impairment who receive enoxaparin. Because enoxaparin is frequently used and outcomes can be life saving or life threatening, we encourage further study of the appropriate dose in patients with moderate renal impairment.</span> 172 22 1713 1718 10.1001/2013.jamainternmed.369 http://archinte.jamanetwork.com/article.aspx?articleID=1389241 http://archinte.jamanetwork.com/article.aspx?articleID=1389242 Mon, 10 Dec 2012 00:00:00 GMT Minichiello T. <span class="paragraphSection">Bleeding is the most feared complication of anticoagulant therapy and, unfortunately, it is not uncommon. The 2011-2012 National Patient Safety Goals mandate efforts to “reduce the likelihood of patient harm associated with the use of anticoagulant therapy.” This is a call for coordinated efforts to decrease adverse events related to anticoagulant therapy, with recommendations for improved oversight and evidence-based management of these agents in the inpatient and outpatient settings.</span> 172 22 1718 1720 10.1001/2013.jamainternmed.456 http://archinte.jamanetwork.com/article.aspx?articleID=1389242