Clinical outcomes in patients with renal impairment and therapeutic dalteparin treatment

Abstract

Introduction: To prevent bio-accumulation of low molecular weight heparins in patients with decreased kidney function, dosage reduction and anti-Xa monitoring is recommended. The aim of this study was to investigate the relationship between adjusted and non-adjusted dosage of therapeutic dalteparin with clinical outcomes (major bleedings, thrombosis and mortality)

Methods: In this monocentric retrospective observational study, we recruited patients with renal impairment who received treatment with a therapeutic dosage of dalteparin without monitoring of anti-Xa levels clinically admitted between January 2012 and March 2022. Included patients were divided over two groups according to the amount of daily administered international units dalteparin per kilogram. Cox proportional hazard analyses were used to estimate hazard ratios to investigate the association between adjusted tDTP and clinical outcomes. Follow-up time for major bleedings and thrombosis was seven days after discontinuation of tDTP treatment or discharge and three months after discharge for mortality.

Results: 108 patients with a therapeutic dosage of dalteparin and renal impairment were included in our study, of which 31 (28.4%) received an adjusted dosage and 77 (71.6%) a non-adjusted dose. Major bleedings occurred in 12 patients (11.1%); thrombosis in 0 patients (0%); and 25 patients (23.1%) died during follow-up. The mean follow-up for major bleedings was 12 days (IQR 7-17); 13 days (IQR 8-18) for thrombosis; and 100 days (IQR 94-111) for mortality. No association was seen between dosage of therapeutic dalteparin and clinical endpoints.

Conclusion: Dosage reduction of therapeutic Dalteparin in patients with renal impairment was not associated with a decreased risk for major bleedings, thrombosis and mortality