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Contraindicated enoxaparin, eptifibatide linked with increased risk for bleeding, mortality in dialysis patients undergoing PCI
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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 percutaneous coronary intervention. 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 percutaneous coronary intervention.”
For more information:
- Tsai TT. JAMA. 2009;302:2458-2464.