Comparing low-molecular-weight heparin dosing for treatment of venous thromboembolism in patients with obesity (RIETE registry).
Por:
Mirza R, Nieuwlaat R, López-Núñez JJ, Barba R, Agarwal A, Font C, Ciammaichella M, Grandone E, Ikesaka R, Crowther M, Monreal M and RIETE Investigators
Publicada:
9 jun 2020
Resumen:
Because of the absence of comparative evidence, current guidelines and product monographs diverge in the dosing of low-molecular-weight heparin (LMWH) for obese patients with venous thromboembolism (VTE). We used the RIETE registry to compare the primary composite outcomes (VTE recurrence, major bleeding, or death) in patients with VTE who weighed >100 kg during LMWH therapy with capped doses of LMWH (18 000 IU/d) vs uncapped doses (>18 000 IU/d). Multivariable logistic regression analysis was used to account for possible confounders. A total of 2846 patients who weighed >100 kg were included: 454 (16%) received capped doses of LMWH, and the remaining 2392 received uncapped doses. Mean (standard deviation) LMWH treatment duration was 14.8 (20.6) and 14.3 (32.3) days, respectively. Thirty-one patients (1.9%) had VTE recurrences, 38 (1.3%) had bleeding episodes, 65 (2.3%) died, and 122 (4.3%) had at least 1 of the composite outcomes. Unadjusted outcome rates revealed that capped dosing was associated with a decrease in the composite outcome (rate ratio, 0.22; 95% confidence interval [CI], 0.04-0.75). Multivariable analysis confirmed that patients who received capped doses had significantly lower rates of the composite outcome (odds ratio, 0.16; 95% CI, 0.04-0.68) while receiving LMWH. These retrospective observational data suggest that capped dosing of LMWH is an acceptable alternative to uncapped dosing based on body weight, given the significantly lower composite event rate of VTE recurrence, major bleeding, and all-cause death.
Filiaciones:
Mirza R:
Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
Nieuwlaat R:
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
López-Núñez JJ:
Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Spain
Facultad de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
Barba R:
Department of Internal Medicine, Hospital Rey Juan Carlos, Madrid, Spain
Agarwal A:
Department of Medicine, University of Toronto, Toronto, ON, Canada
Font C:
Department of Medical Oncology, Hospital Clínic, Barcelona, Spain
Ciammaichella M:
Department of Emergency Internal Medicine, Ospedale St John, Rome, Italy
Grandone E:
Atherosclerosis and Thrombosis Unit, Casa Sollievo Della Sofferenza, Foggia, Italy
and
Ikesaka R:
Division of Hematology, Department of Medicine, McMaster University, Hamilton, ON, Canada
Crowther M:
Division of Hematology, Department of Medicine, McMaster University, Hamilton, ON, Canada
Monreal M:
Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Spain
Facultad de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
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