Critical Care Journal Club esis ln C, Da M, Gan Mt. Envaparin versus uriractionatedhepacin For venus tremboembolim ‘ophylags in enaly impairs cU pains. Phormacarerapy. 2021; $1:428-829. resented by Else Mar, Phar Boekeround and Overview 1G pens with rena nsficlney are mor iy to develop venous twomboembolm VTE] and are also at serncrened ei or blading 1+ Theres config ts on whether noxaparn or uneaconated heparin (UF: related in pases with renal djlurtion. 1+ Lowel weight heparin {NAW ns shown upenonty to Un patent popultons uch as 2c Ischermc stake wip potas, aura, pane, and malganey Adana othe general ICD Popuatlon UMUH arose with ss thrombotic event without on nceasein bleeding + Taide Basted etting IMT ad ang UF or VTE propa patents wth CIAO Lin. Te sua demorstvated less mjrbeeding with UFH, with ne difernce nthe rate of VE + Paks Compared theeleary srl salety of ropa WH us UF in ptent with ESRD The soberoup ana showed no iferencenmojr beeing oF tromboerbai events + Green MS: Damenstated no aiferenceinhvomboss compost of tending events in redial erode gatlnt recng UE or LMWH Tor VTE pron Conpsrative (Objective _| To eslate the safety of prophylactic doses of enoraparin versus UF In CU paints with renal impsimnt. ‘Method “ng cee, respective cohort study at Acesion St.John Hompialin Dero between August 2035 and Februay 2020, N40 (orapain 231, UF e229) Treason Cela ‘xciosan Gea + panyensatd + Renalimpaiment (tne as Ak severely deereased eral union, and SRO) + length of stay372 hare 1 Recwed propyl doses of subewaneous Documented mer ied the st oaths Detvebleed Mateet count <0,000/mroter emission INR>L-8 ‘admisslon a > upper int of eral 70.0 SiyOeen ‘enasaparin oF UP for atleast 72 hours wen sec tre + Nd or therapeutic ateanguation ot rophvts) + Coapuopaties (vn Wilebrond cassie ‘ataneni) + Documented VIE withinest 3 months Intervention: CU patient with rena impairment recived VTE propyl with ether enoxparn or UH mary Edin + proportion of patentin each eroup who experianced at ast one mao blading event ding the howpltakeaton per iternatonsl Soc of Trombei STH) defn cxtcomes_ | secondary trdpoints: 7 Proportion of paintsin each roup wth VTE daringhospitaladmisionconimed by imaging 1 Theproportonofmsor and minor leading events (per TM eo) + pha = 005 stattkal | + Powers 95% (230 subjects requ foreach rou) ‘eaiiss | + Oisquare aah used for endpoins wth git regression mode fr confounding variablesReaute staline characteris 1 Saeandferencs: noxaparin vs. UF > Procedre perl dug hospital stay (2625. 130; pe <2) rset plotlt (268) "20, 2434) 11% pe <0.) © Baseina Hg (128 1-23 5.116 2.8; p= <0) 1 1 lestion|SICU 147 v5.55; MICU 63.112; 001) © Ghesing C03. ¥/- 9626.61.34 38.0; 92003) © ConcomtanIV SAD ure (59 34 9= <0) Concantant dua antlatiet se (385. 81:P<4) Stores primary Endpoint: Popoton of ptins who experienced ot as one SH defined major bleeding even ‘dso, 35% Conidence interval | pale ronapoin FR). 1143.08 0 Outcome Thon a ale THM joe 16169), Baa) 10 “i Minor Bled | 39463) (24) 05 WT acFe 20183 5G) oe Tetkar? | Theres an erased rk of major Blas hci ations wth eal ipairment when econg propyl nciuvions _| enenaparin compared to UPN, lina shoud weigh the ees benef of ng enopain nea paler Concatone ‘Stents 1 Covered several hundred patents ars 5 yrs, incessing power ofthe study and internal aly 1 Investigators ckncnedged several diferncesin baseline charters and conde sanity anaes nd lage regression to ihn for contouring varies 1+ Gale of primary autzome corespands with esting sts, however, conubutes adtinaafarmation on patents wth AKI lahore the carer erature acing Limitation: 1 ak acount for the sry of rena impsrentinpaentsincued in the study iting generazablity ofthe study esas to ‘ther populations wth ehvonerenalimparment + Revaspecive cahat study design dna alow or study subject randomization to typeof anticoaeuation se, itinginte vai + Tiesto war unl to comer variationsin patient subgroups ferent stages/sevety feat eral impalement) Presenter Condusions: + Super o enoxopn versus UF fr VIE propria ghy dependent upan the patient population However theres teidones that enor in CU pants th anal sunctn may eae to ncteaseabledngavets du beng renal lminatod + Thestudy dines pet that healtneare provider sad tee nto account rena freon of aly it patents when choose ‘etreen enosaprin ot UP fr VE prophyons + Biferences in reported leeding isk a naxaparin vs. UPA for VE propa n primar Ierture is ih dependent on what beeding definitions aeutited nia Appa and impact on Loca Practie: cer takenan eth anocongulbten concen GUGEIneS UR prefrea over enoxapah for VE prophyaas nr uncon (Cec 0m or ESO. Realy ste enoxapein may alo be ule, enoxaprn is domed nocesary i 3 hemodayss patient ant montrrg srecommonded + Thisstudysupoore te safety and ec of Eeenanscrrent protocol howevert des not eet spperta sede cet {cal rates ay beet om abo using UF fr VE propos in CU patents wth eal ipalmant if ot already bing done. 2 Faison Onemon Mt Lon mcr net etn vere el teh endnote 2 Sate tur aa Sey aryl ape cenpet thn ep ean ambi epin ‘emote gr, SOD 4 Studion dom cnt mg enarntactontes hepa even branboentkn che prsEskenazi Health ritical Care Journal Club Prosontation Evaluation Form ate: ——thales Resident: = Av Journal Artidle; ‘Reseasment Scale: Information pertinent to the topic using @coract ‘summary of and comparison to avalable primary Tierature exe nt ‘resefler provides an aoturale and bit description ofthe study goal, methodology, and resus. exe ™ Presenter appropriately discusses atibules and ‘efciencies of sudy methodology. When ‘efeencies are noted, a proposes technique to Improve tne faw i provided exc Gr wt Preeti conmers on be appronatnees of este! mettode wed iw resol poids Tar own cons Tay upped by sound easonng exe (AT) NI Presenter determines the study impact on cinial practice and provides logical explanation of hiner opinion exc Coat Mt Presenter ures professional language, pears Cote medica avaneale Resting coyn't Sell youre, Sat re eee laa teet be Stake exe (Sai) WL ye eke ae ane reste delay bly apron ane Monte uestons, exe (43) Evakator__WiatMer? 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