单位：[1]China Japan Friendship Hosp, Natl Ctr Resp Med, Inst Clin Med Sci, Beijing, Peoples R China[2]Chinese Acad Med Sci, Inst Resp Med, Beijing, Peoples R China[3]Capital Med Univ, Beijing Chao Yang Hosp, Dept Pulm & Crit Care Med, Beijing, Peoples R China北京朝阳医院[4]Beijing Hosp, Natl Ctr Gerontol, Dept Pulm & Crit Care Med, Beijing, Peoples R China[5]Chinese Acad Med Sci, Inst Geriatr Med, Beijing, Peoples R China[6]Tongji Univ, East Hosp, Dept Pulm & Crit Care Med, Sch Med, Shanghai, Peoples R China[7]Sichuan Univ, Dept Pulm & Crit Care Med, West China Hosp, Chengdu, Peoples R China四川大学华西医院[8]Chongqing Med Univ, Dept Pulm & Crit Care Med, Affiliated Hosp 1, Chongqing, Peoples R China重庆医科大学附属第一医院[9]Shanxi Med Univ, Hosp 1, Taiyuan, Peoples R China[10]Chinese Acad Med Sci & Peking Union Med Coll, Fuwai Hosp, Natl Ctr Cardiovasc Dis, Dept Cardiol, Beijing, Peoples R China[11]Henan Univ Sci & Technol, Dept Pulm & Crit Care Med, Affiliated Hosp 1, Luoyang, Peoples R China[12]Jilin Univ, Hosp 2, Dept Pulm Crit Care Med, Changchun, Jilin, Peoples R China[13]Peking Union Med Coll Hosp, Dept Pulm & Crit Care Med, Beijing, Peoples R China[14]China Japan Friendship Hosp, Ctr Resp Med, Dept Pulm & Crit Care Med, Beijing, Peoples R China[15]Natl Ctr Resp Med, Beijing, Peoples R China[16]Capital Med Univ, Beijing Anzhen Hosp, Dept Pulm & Crit Care Med, Beijing, Peoples R China首都医科大学附属安贞医院[17]Dalian Med Univ, Dept Pulm & Crit Care Med, Affiliated Hosp 1, Dalian, Peoples R China大连医科大学附属第一医院[18]Natl Clin Res Ctr Resp Dis, Beijing, Peoples R China[19]Chinese Acad Med Sci, Peking Union Med Coll, Beijing, Peoples R China[20]Capital Med Univ, Dept Resp Med, Beijing, Peoples R China
Background: Renal function is associated with prognoses for acute pulmonary embolism (PE). Objective: To investigate the application of anticoagulants and dosage of LMWH among patients with renal insufficiency (RI), and the association between LWMH dosage and the patients' in-hospital outcomes. Methods: Adult patients diagnosed with non-high risk acute PE from 2009 to 2015, with available data of creatinine clearance (CCr) were enrolled from a multicenter registry in China. Renal insufficiency (RI) was defined as CCr <60 ml/min. LMWH dosage was converted into IU/kg daily dose and presented as adjusted dose (<= 100 IU/kg/day) and conventional dose (>100 IU/kg/day). All-cause death, PE-related death and bleeding events during hospitalization were analyzed as endpoints. Results: Among the enrolled 5870 patients, RI occurred in 1311 (22.3%). 30 <= CCr < 60 ml/min was associated with higher rate of bleeding events and CCr < 30 ml/min was associated with all-cause death, PE-related death and major bleeding. Adjusted-dose LMWH was applied in 26.1% of patients with 30 <= CCr < 60 ml/min and in 26.2% of CCr < 30 ml/min patients. Among patients with RI, in-hospital bleeding occurred more frequently in those who were administered conventional dose of LMWH, compared with adjusted dose (9.2% vs 5.0%, p = 0.047). Adjusted dose of LMWH presented as protective factor for in-hospital bleeding (OR 0.62, 95%CI 0.27-1.00, p = 0.0496) and the risk of bleeding increased as length of hospital stay prolonged (OR 1.03, 95%CI 1.01-1.06, p = 0.0014). Conclusions: The proportion of adjusted usage of LMWH was low. The application of adjusted-dose LMWH was associated with lower risk of in-hospital bleeding for RI patients, in real-world setting of PE treatment. Anticoagulation strategy for RI patients should be paid more attention and requires evidence of high quality.
基金：
Fund of The National Key R&D Program of China [2018YFC1315100, 2016YFC0905600]; China Key Research Projects of the 11th National Five-Year Development Plan [2006BAI01A06]; China Key Research Projects of the 12th National Five-Year Development Plan [2011BA11B17]; CAMS Innovation Fund for Medical Sciences (CIFMS) [2018-I2M-1-003]; China-Japan Friendship Hospital Grant [2019-2-QN-78]
第一作者单位：[1]China Japan Friendship Hosp, Natl Ctr Resp Med, Inst Clin Med Sci, Beijing, Peoples R China[2]Chinese Acad Med Sci, Inst Resp Med, Beijing, Peoples R China
共同第一作者：
通讯作者：
通讯机构：[2]Chinese Acad Med Sci, Inst Resp Med, Beijing, Peoples R China[14]China Japan Friendship Hosp, Ctr Resp Med, Dept Pulm & Crit Care Med, Beijing, Peoples R China[15]Natl Ctr Resp Med, Beijing, Peoples R China[18]Natl Clin Res Ctr Resp Dis, Beijing, Peoples R China[19]Chinese Acad Med Sci, Peking Union Med Coll, Beijing, Peoples R China[20]Capital Med Univ, Dept Resp Med, Beijing, Peoples R China
推荐引用方式(GB/T 7714)：
Wang Dingyi,Fan Guohui,Lei Jieping,et al.LMWHs dosage and outcomes in acute pulmonary embolism with renal insufficiency, an analysis from a large real-world study[J].THROMBOSIS JOURNAL.2022,20(1):doi:10.1186/s12959-022-00385-z.
APA：
Wang, Dingyi,Fan, Guohui,Lei, Jieping,Yang, Yuanhua,Xu, Xiaomao...&Zhai, Zhenguo.(2022).LMWHs dosage and outcomes in acute pulmonary embolism with renal insufficiency, an analysis from a large real-world study.THROMBOSIS JOURNAL,20,(1)
MLA：
Wang, Dingyi,et al."LMWHs dosage and outcomes in acute pulmonary embolism with renal insufficiency, an analysis from a large real-world study".THROMBOSIS JOURNAL 20..1(2022)
