Abstract: TH-PO807

Association between Low-Molecular-Weight Heparin and Risk of Bleeding among Hemodialysis Patients: A Retrospective Cohort Study

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Lazrak, Hind Harrak, Maisonneuve-Rosemont hospital, Montreal, Quebec, Canada
  • Rene, Emilie, Maisonneuve-Rosemont hospital, Montreal, Quebec, Canada
  • Elftouh, Naoual, Maisonneuve-Rosemont hospital, Montreal, Quebec, Canada
  • Nadeau-Fredette, Annie-Claire, Maisonneuve-Rosemont hospital, Montreal, Quebec, Canada
  • Laurin, Louis-Philippe, Maisonneuve-Rosemont hospital, Montreal, Quebec, Canada
  • Lafrance, Jean-Philippe, Maisonneuve-Rosemont hospital, Montreal, Quebec, Canada
Background

Low molecular weight heparins (LMWH) replaced unfractionated heparin (UFH) in multiple indications. While their efficacy in hemodialysis was proved through multiple studies, their safety remains controversial. The potential bioaccumulation in patients undergoing chronic hemodialysis raised the question of bleeding risk among this population.
The aim of this study was to evaluate bleeding risk among patients with chronic hemodialysis receiving LMWH or UFH for the extracorporeal circuit anticoagulation.

Methods

We conducted a retrospective cohort study of patients undergoing chronic hemodialysis in 22 participating centers using data extracted from administrative databases in Quebec, Canada, from January 2007 to March 2013. Minor, major and total bleeding risk for a first event with LMWH compared to UFH was estimated using a proportional Cox model with time-dependent exposure using demographics, comorbidities and drug use as covariates.

Results

We identified 5322 prevalent and incident chronic hemodialysis patients. The incidence rate for minor, major and total bleeding was 9.5 events /1000 patient-year (95%CI: 7.6-11.0), 24.2 events /1000 patient-year (95%CI: 21.5-27.1) and 32.9 events /1000 patient-year (95%CI: 29.8-36.3) respectively. We found similar risks of minor (adjusted hazard ratio (HR)=1.04; 95%CI: 0.67-1.61), major (HR=0.84; 95%CI: 0.64-1.10) and total bleeding (HR=0.91; 95%CI: 0.72-1.15) when comparing LMWH to UFH.

Conclusion

LMWH was not associated with a higher minor, major or total bleeding risk compared to UFH in a large cohort of chronic hemodialysis patients. LMWH is a suitable alternative to UFH in hemodialysis.