LMWHs dosage and outcomes in acute pulmonary embolism with renal insufficiency, an analysis from a large real-world study

Dingyi Wang; Guohui Fan; Jieping Lei; Yuanhua Yang; Xiaomao Xu; Yingqun Ji; Qun Yi; Hong Chen; Xiaoyun Hu; Zhihong Liu; Yimin Mao; Jie Zhang; Juhong Shi; Zhu Zhang; Sinan Wu; Xincao Tao; Wanmu Xie; Jun Wan; Yunxia Zhang; Shuai Zhang; Kaiyuan Zhen; Zhonghe Zhang; Baomin Fang; Chen Wang; Zhenguo Zhai; China pUlmonary thromboembolism REgistry Study (CURES) investigators

doi:10.1186/s12959-022-00385-z

LMWHs dosage and outcomes in acute pulmonary embolism with renal insufficiency, an analysis from a large real-world study

Thromb J. 2022 May 5;20(1):26. doi: 10.1186/s12959-022-00385-z.

Authors

Dingyi Wang^#^{1

2}, Guohui Fan^#^{1

2}, Jieping Lei^{1

2}, Yuanhua Yang³, Xiaomao Xu^{4

5}, Yingqun Ji⁶, Qun Yi⁷, Hong Chen⁸, Xiaoyun Hu⁹, Zhihong Liu¹⁰, Yimin Mao¹¹, Jie Zhang¹², Juhong Shi¹³, Zhu Zhang^{2

14

15}, Sinan Wu^{1

2}, Xincao Tao^{2

14

15}, Wanmu Xie^{2

14

15}, Jun Wan¹⁶, Yunxia Zhang^{2

14

15}, Shuai Zhang^{2

14

15}, Kaiyuan Zhen^{2

14

15}, Zhonghe Zhang¹⁷, Baomin Fang^{5

17}, Chen Wang^{18

19

20

21

22

23}, Zhenguo Zhai^{24

25

26}; China pUlmonary thromboembolism REgistry Study (CURES) investigators

Affiliations

¹ Institute of Clinical Medical Sciences, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
² Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.
³ Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
⁴ Department of Pulmonary and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Beijing, China.
⁵ Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
⁶ Department of Pulmonary and Critical Care Medicine, East Hospital, Tongji University School of Medicine, Shanghai, China.
⁷ Department of Pulmonary and Critical Care Medicine, Sichuan University West China Hospital, Chengdu, China.
⁸ Department of Pulmonary and Critical Care Medicine, Chongqing Medical University First Affiliated Hospital, Chongqing, China.
⁹ First Hospital of Shanxi Medical University, First Hospital of Shanxi Medical University, Taiyuan, China.
¹⁰ Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
¹¹ Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China.
¹² Department of Pulmonary Critical Care Medicine, Jilin University Second Hospital, Changchun, China.
¹³ Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Beijing, China.
¹⁴ Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
¹⁵ National Center for Respiratory Medicine, Beijing, China.
¹⁶ Department of Pulmonary and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
¹⁷ Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, China.
¹⁸ Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China. wangchen@pumc.edu.cn.
¹⁹ Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China. wangchen@pumc.edu.cn.
²⁰ National Center for Respiratory Medicine, Beijing, China. wangchen@pumc.edu.cn.
²¹ National Clinical Research Center for Respiratory Diseases, Beijing, China. wangchen@pumc.edu.cn.
²² Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China. wangchen@pumc.edu.cn.
²³ Department of Respiratory Medicine, Capital Medical University, Beijing, China. wangchen@pumc.edu.cn.
²⁴ Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China. zhaizhenguo2011@126.com.
²⁵ Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China. zhaizhenguo2011@126.com.
²⁶ National Center for Respiratory Medicine, Beijing, China. zhaizhenguo2011@126.com.

^# Contributed equally.

Abstract

Background: Renal function is associated with prognoses for acute pulmonary embolism (PE).

Objective: To investigate the application of anticoagulants and dosage of LMWH among patients with renal insufficiency (RI), and the association between LWMH dosage and the patients' in-hospital outcomes.

Methods: Adult patients diagnosed with non-high risk acute PE from 2009 to 2015, with available data of creatinine clearance (CCr) were enrolled from a multicenter registry in China. Renal insufficiency (RI) was defined as CCr < 60 ml/min. LMWH dosage was converted into IU/kg daily dose and presented as adjusted dose (≤ 100 IU/kg/day) and conventional dose (> 100 IU/kg/day). All-cause death, PE-related death and bleeding events during hospitalization were analyzed as endpoints.

Results: Among the enrolled 5870 patients, RI occurred in 1311 (22.3%). 30 ≤ CCr < 60 ml/min was associated with higher rate of bleeding events and CCr < 30 ml/min was associated with all-cause death, PE-related death and major bleeding. Adjusted-dose LMWH was applied in 26.1% of patients with 30 ≤ CCr < 60 ml/min and in 26.2% of CCr < 30 ml/min patients. Among patients with RI, in-hospital bleeding occurred more frequently in those who were administered conventional dose of LMWH, compared with adjusted dose (9.2% vs 5.0%, p = 0.047). Adjusted dose of LMWH presented as protective factor for in-hospital bleeding (OR 0.62, 95%CI 0.27-1.00, p = 0.0496) and the risk of bleeding increased as length of hospital stay prolonged (OR 1.03, 95%CI 1.01-1.06, p = 0.0014).

Conclusions: The proportion of adjusted usage of LMWH was low. The application of adjusted-dose LMWH was associated with lower risk of in-hospital bleeding for RI patients, in real-world setting of PE treatment. Anticoagulation strategy for RI patients should be paid more attention and requires evidence of high quality.

Trial registration: The CURES was registered in ClinicalTrias.gov, identifier number: NCT02943343 .

Keywords: Acute pulmonary embolism; Adjusted dosage; Low molecular weight heparin; Prognoses; Renal insufficiency.

Associated data

ClinicalTrials.gov/NCT02943343

Abstract

Associated data

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