Estimated glomerular filtration rate versus creatinine clearance to determine anticoagulant dosage after lower-limb orthopedic surgery

Abstract

Abstract Aim This retrospective study aimed to determine whether different renal function estimation formulas affect the incidence of venous thromboembolism (VTE) and bleeding when anticoagulant dosages were determined. Methods The study included patients who underwent lower-limb orthopedic surgery and were treated with anticoagulants between January 2017 and March 2020 at Yaizu City Hospital. The appropriateness of anticoagulant dosing was assessed using creatinine clearance (CCr) and estimated glomerular filtration rate (eGFR), and the incidence of VTE and bleeding was compared among the different renal function estimation formulas. Results The median values for body surface area, CCr, and eGFR were 1.40m2, 56.0mL/min, 73.0mL/min/1.73m2, respectively. There was no significant difference in the incidence of VTE among the different renal function estimation formulas. However, when the threshold for dose reduction or contraindication was determined by eGFR rather than CCr, the incidence of bleeding was significantly higher in the group that was overdosed in CCr (6.0% vs 25.7% p < 0.05). Conclusion It is necessary to set the dosage of anticoagulants based on CCr for patients with a small body surface area in the field of orthopedics to avoid the risk of bleeding.