Evaluation of Enoxaparin for Inpatient Venous Thromboembolism Prophylaxis in End-Stage Renal Disease Patients on Hemodialysis

Abstract

Background: Enoxaparin is not recommended for venous thromboembolism (VTE) prophylaxis in the end-stage renal disease (ESRD) on hemodialysis (HD) population due to concerns for drug accumulation and increased bleeding risk. Due to the paucity of literature with clinical outcomes to support this theoretical safety concern, the purpose of this study was to compare the risks of bleeding of enoxaparin and unfractionated heparin (UFH) in hospitalized, HD-dependent patients. Methods: This retrospective cohort study examined ESRD on HD patients who received either subcutaneous enoxaparin or UFH for VTE prophylaxis and were admitted for at least 48 hours. The primary outcome was major bleeding or clinically relevant non-major bleeding (CRNMB) as guided by definitions from the International Society of Thrombosis and Haemostasis. Results: A total of 322 enoxaparin and 10 UFH patients were analyzed. All enoxaparin patients were dosed 30 mg subcutaneous daily. Twenty-two (6.8%) enoxaparin and zero UFH patients experienced major or CRNMB ( P = .498). Three enoxaparin patients suffered fatal hemorrhages. Multiple logistic regression demonstrated thrombocytopenia was associated with bleeding (odds ratio 4.23, P = .004). Conclusion: The difference in major or CRNMB rates between both anticoagulants was not statistically significant. However, the 6.8% bleed rate is concerning for inpatient enoxaparin usage, and caution should be applied when considering this drug for VTE prophylaxis in the ESRD on HD population.