No abstract

Phytonadione (vitamin K1, VK) is fat soluble and may be sequestered by adipose tissue, thus potentially altering drug distribution in obese patients requiring warfarin reversal. This single-center retrospective cohort study aimed to determine the effects of obesity (defined as body mass index [BMI] ≥ 30 kg/m 2 ) on warfarin reversal following administration of VK in adult patients. The primary outcome was complete or partial warfarin reversal (defined as an international normalized ratio [INR] ≤ 2.0) within 72 hours post-VK administration. Of 688 identified patients, 215 were included in primary INR analysis. Mean BMIs for obese (n = 84) and nonobese (n = 131) patients were 37.3 and 24.3 kg/m 2 ( P < .001), and mean baseline INRs were 4.73 and 4.42 ( P = .534), respectively. Within 72 hours post-VK administration, 70% and 69% of the obese and nonobese groups, respectively, achieved complete or partial warfarin reversal ( P = .904). Multiple logistic regression determined baseline INR and concomitant fresh frozen plasma administration to be factors influencing warfarin reversal. These findings do not suggest obesity is significantly associated with a decreased likelihood of warfarin reversal within 72 hours post-VK administration.

Background: Enoxaparin is not recommended for venous thromboembolism (VTE) prophylaxis in the end-stage renal disease (ESRD) on hemodialysis (HD) population due to concerns for drug accumulation and increased bleeding risk. Due to the paucity of literature with clinical outcomes to support this theoretical safety concern, the purpose of this study was to compare the risks of bleeding of enoxaparin and unfractionated heparin (UFH) in hospitalized, HD-dependent patients. Methods: This retrospective cohort study examined ESRD on HD patients who received either subcutaneous enoxaparin or UFH for VTE prophylaxis and were admitted for at least 48 hours. The primary outcome was major bleeding or clinically relevant non-major bleeding (CRNMB) as guided by definitions from the International Society of Thrombosis and Haemostasis. Results: A total of 322 enoxaparin and 10 UFH patients were analyzed. All enoxaparin patients were dosed 30 mg subcutaneous daily. Twenty-two (6.8%) enoxaparin and zero UFH patients experienced major or CRNMB ( P = .498). Three enoxaparin patients suffered fatal hemorrhages. Multiple logistic regression demonstrated thrombocytopenia was associated with bleeding (odds ratio 4.23, P = .004). Conclusion: The difference in major or CRNMB rates between both anticoagulants was not statistically significant. However, the 6.8% bleed rate is concerning for inpatient enoxaparin usage, and caution should be applied when considering this drug for VTE prophylaxis in the ESRD on HD population.