Authors: Ma Jesús Bruscas José Antonio Nieto Monserrat PerezPinar Luciano LópezJiménez Carmen FernándezCapitán Francisca LópezChuliá Ma Teresa OrueLecue for the RIETE Investigators
Publish Date: 2007/04/17
Volume: 86, Issue: 7, Pages: 519-526
Abstract
The objective was to assess the use of suboptimal doses 60–149 UI kg−1 day−1 of low molecular weight heparin LMWH in the treatment of acute venous thromboembolism VTE in actual clinical practice and to evaluate the outcomes compared to standard doses ≥150 UI kg−1 day−1 Retrospective analysis of data from a multicenter registry of patients with VTE RIETE Registro Informatizado de Enfermedad TromboEmbólica Patient characteristics antithrombotic treatments and 3month outcomes were analyzed We studied 12302 patients with VTE 10524 patients were treated initially only with LMWH 1547 patients received suboptimal LMWH mean = 122 UI kg−1 day−1 and 8977 patients received fulldose LMWH mean = 191 UI kg−1 day−1 The suboptimal group included significantly more patients with recent major bleeding weight more than 100 kg raised creatinine or deep vein thrombosis No significant differences in mortality rate 77 vs 78 VTE recurrence 27 vs 23 or fatal hemorrhage 06 vs 06 occurred between the suboptimal and the standard group Major bleeding episodes occurred more frequently in the patients with pulmonary embolism treated with suboptimal LMWH 45 vs 24 p = 002 In the multivariate analysis after adjusting for bleeding risk factors major hemorrhage was not associated with the heparin dose Suboptimal doses of LMWH are used in actual clinical practice in a reduced group of patients at an outcome rate not very different to that of standard doses Bleeding episodes depend more on the patient’s characteristics than on the LMWH dose Randomized trials should be performed to corroborate these resultsWe express our gratitude to SanofiAventis for supporting this registry with an unrestricted educational grant and the Registry Coordinating Center S H Medical Science Service for their logistic and administrative support We thank Ms Uta M Klepzig for the assistance in the preparation of the manuscript The project has been partially supported by Red Respira from the Instituto Carlos III RedRespiraISCiiiRTIC03/11Spain Arcelus JI Barba R Blanco A Barrón M Bugés J Cabezudo MA Casado I Conget F De las Heras G Falgá C FernándezCapitán C Font L Gallego P GarcíaBragado F González CR Grau E Guijarro R Guil M Gutiérrez J Hernández L Jiménez D Laserna E Lecumberri R Lobo JL López F López L López I Maestre A Martín JJ Monreal M Naufall MD Nieto JA Orue MT Otero R Pedrajas JM Portillo J Rabuñal R Raguer E Raventos A Román P Romero C Rosa V Sampériz AL Sánchez R Sánchez JF Soler S Tiberio G Tirado R Tolosa C Trujillo J Uresandi F Valle R Vasco B and Llobet X Medical Department Sanofi Aventis
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