Low-molecular-weight heparin venous thromboprophylaxis in critically ill patients with renal dysfunction: A subgroup analysis of the PROTECT trial.

Menaka Pai
Neill K J Adhikari
Marlies Ostermann
Diane Heels-Ansdell
James D Douketis
Yoanna Skrobik
Ismael Qushmaq
Maureen Meade
Gordon Guyatt
William Geerts
Michael W Walsh
Mark A Crowther
Jan O Friedrich
Lisa Burry
Rinaldo Bellomo
Nilton Brandão da Silva
Rubens Costa Filho
Michael J Cox
Suzana Alves Silva
Deborah J Cook
PROTECT (Prophylaxis for Thromboembolism in Critical Care Trial) Investigators

Open link

Publication date

January 2018

DOI

10.1371/journal.pone.0198285

Publisher

Public Library of Science (PLoS)

Journal

PLoS ONE

Abstract

INTRODUCTION:There is concern about excessive bleeding when low-molecular-weight heparins (LMWHs) are used for venous thromboembolism (VTE) prophylaxis in renal dysfunction. Our objective was to evaluate whether LMWH VTE prophylaxis was safe and effective in critically ill patients with renal dysfunction by conducting a subgroup analysis of PROTECT, a randomized blinded trial. METHODS:We studied intensive care unit (ICU) patients with pre-ICU dialysis-dependent end-stage renal disease (ESRD; pre-specified subgroup; n = 118), or severe renal dysfunction at ICU admission (defined as ESRD or non-dialysis dependent with creatinine clearance [CrCl] <30 ml/min; post hoc subgroup; n = 590). We compared dalteparin, 5000 IU daily, with unfractionate...