Transcript Factors that may cause Bleeding with Enoxaparin

Factors that may cause Bleeding with Enoxaparin
Ohoud M. Alarfaj, Hisham S. Abou-Auda, Ahmad Al-Barraq, Mohammad H. Daba.
Methodology
Objective
To determine the factors that may affect LMWH such as (weight,
renal function, drugs and disease). and to check if there is any
Bleeding & Number of drugs
• A retrospective trial, conducted in King Khalid
correlation between occurrence of bleeding and these factors among
University Hospital (KKUH) including 400 patients
patients receiving LMWH.
(178 male and 222 female).
• A special data collection form was used.
Introduction
Drugs
Bleeding (%)
Aspirin
44 (46.8 %)
Warfarin
Diclofenac
Ibuprofen
Clopidogril
Digoxin
23
19
14
13
5
N0. of drugs
0
1
2
3
4
(24.5 %)
(20.2 %)
(14.9 %)
(13.8 %)
(5.3 %)
Bleeding (%)
26.6%
22.8%
22.2%
20.0%
42.6%
• Enoxaparin is in a class of medications called low molecular
Bleeding & Number of diseases
weight heparins (LMWH).
• In 1982 Kakkar et al was the first one who evaluates LMWH in
Results
humans.
• LMWH is a class of medication used as an anticoagulant in
diseases that cause thrombosis, as well as prophylaxis in
Bleeding & Weight
situations that lead to a high risk of thrombosis.
• Used for several days after hip or knee replacement surgery , and
49 %
in some cases following abdominal surgery, also patients who
Normal
unable to walk.
Underweight
• Due to the hydrophilic disposition of enoxaparin, accumulation is
risk of hemorrhagic complications if standard weight adjusted
Overweight
22 %
27 %
treatment doses are used.
• Obesity is a world wide health problem that is highly correlated
Bleeding (%)
N0. of disease Bleeding (%)
39 (41.5 %)
40 (42.6 %)
5 ( 5.3 % )
19 (20.2 %)
9 (20.2 %)
19 (20.2 %)
2 ( 2.1 % )
0
1
2
3
4
17.4%
28.4%
23.6%
24.6%
40.0%
2%
Obese
likely in patients with renal dysfunction thereby increasing the
Disease
HTN
DM
Heart Failure
Pregnancy
Renal Failure
IHD
CAD
Bleeding & Renal Function
Conclusion
There is an increase in bleeding episode in patients with renal
failure (P=0.012) than patients with normal renal function. The
with morbidity and mortality from many disease. Obesity define
risk of bleeding increase by almost two times with increase BMI
according to WHO is a body mass index (BMI)≥30 kg/m²
(≥30). There is also increasing in the risk of bleeding when
• Enoxaparin treatment doses are calculated in terms of actual
20.5 %
25.4 %
42.9 %
warfarin, diclofenac, ibuprofen and clopidogril. In addition there
patient weight, but, because the drug is not distributed in fat, there
is an increase in bleeding with increse no. of diseases (P=0.043).
is a possibility of excessive drug exposure in obese patients.
LMWHs have many adverse effects and the main one is bleeding.
patients receive enoxaparin with more than one drugs of aspirin,
Normal
258
Moderate
114
Failure
28