This article is more than 5 years old. Information may no longer be current.

Contraindicated enoxaparin, eptifibatide linked with increased risk for bleeding, mortality in dialysis patients undergoing PCI

Issue: January 2010

Add topic to email alerts

Receive an email when new articles are posted on

Please provide your email address to receive an email when new articles are posted on .

Subscribe

Added to email alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

Back to Healio

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Back to Healio

The receipt of contraindicated antithrombotic medications after percutaneous coronary intervention was associated with an increased risk for bleeding and death in patients undergoing dialysis, study results suggested.

Researchers evaluated data from 22,778 patients assigned to dialysis who also underwent PCI. The researchers divided the study population into patients who had been administered contraindicated antithrombotic medications (n=5,084) and those who had not (n=17,694). Among the patients administered contraindicated medications, 2,375 (46.7%) were assigned to enoxaparin (Lovenox, Sanofi-Aventis), 3,261 (64.1%) to eptifibatide (Integrilin, Schering) and 552 (10.9%) to both. Patients assigned to warfarin were excluded from the analysis. The primary outcome measure was the incidence of in-hospital bleeding and death.

Major in-hospital bleeding was reported in 805 (3.6%) patients and in-hospital death in 963 (4.5%) patients. Results of an unadjusted analysis suggested that patients assigned to contraindicated medications had higher rates of in-hospital bleeding (5.6% vs. 2.9%; OR=1.93; 95% CI, 1.66-2.23) and in-hospital death (6.5% vs. 3.9%; OR=1.68; 95% CI, 1.46-1.95) vs. those who were not administered contraindicated medications. The association between increased risk for major bleeding (OR=1.66; 95% CI, 1.43-1.92) and death (OR=1.24; 95% CI, 1.04-1.48) remained after multivariable analysis. In a cohort of 10,158 patients matched by propensity scores, being assigned to contraindicated medications was associated with an increased risk for bleeding (OR=1.63; 95% CI, 1.35-1.98) and death (OR=1.15; 95% CI, 0.97-1.36).

“These results appear to validate the FDA–directed labeling of eptifibatide and enoxaparin as contraindicated or not recommended for use in dialysis patients,” the researchers concluded. “Because non-renally cleared antithrombotic alternatives are available, this study supports avoiding the use of enoxaparin and eptifibatide in dialysis patients undergoing PCI.”

For more information:

• Tsai TT. JAMA. 2009;302:2458-2464.