Unlike unfractionated heparin (UFH), the low-molecular-weight heparin
enoxaparin (Lovenox) is excreted mainly by the kidneys. To determine whether
this characteristic heightens bleeding risk in patients with renal
insufficiency, researchers in Connecticut compared bleeding rates with
enoxaparin and UFH in a retrospective study of 620 hospitalized patients
with renal insufficiency.
All patients received full therapeutic doses of enoxaparin or UFH. Renal
insufficiency was mild (glomerular filtration rate, 41-60 mL/minute) in 50%,
moderate (21-40 mL/minute) in 34%, and severe (20 mL/minute) in 16%. In
analyses that were adjusted for potential confounders, rates of major
bleeding did not differ significantly between enoxaparin and UFH recipients,
regardless of the degree of renal impairment. However, minor bleeding was
significantly more common with enoxaparin than with UFH in the subgroup with
severe impairment (rate, 68 vs. 27 minor bleeds per 1000 person-days).
Overall, 10% of patients had major bleeding, and 14% had minor bleeding.

Comment: In this nonrandomized, retrospective study, minor (but not major)
bleeding was significantly more common with enoxaparin than with UFH among
patients with severe renal insufficiency. In December 2003, the official
prescribing information for enoxaparin changed to reflect data from new
manufacturer-sponsored research on enoxaparin pharmacokinetics. For patients
with creatinine clearance <30 mL/minute, the new prescribing information
recommends reduced doses of 30 mg once daily for DVT prophylaxis and 1 mg/kg
once daily for treatment of venous thromboembolism, unstable angina, and
non-Q-wave myocardial infarction. Standard doses still are recommended for
patients with milder degrees of renal impairment.

— Allan S. Brett, MD

Published in Journal Watch April 20, 2004

קישור לאבסטרקט
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=15006942&dopt=Abstract

Source

Thorevska N et al. Anticoagulation in hospitalized patients with renal
insufficiency: A comparison of bleeding rates with unfractionated heparin vs
enoxaparin. Chest 2004 Mar; 125:856-63.

[Original article][Medline abstract][Download citation

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2.בהמשך -הידיעה, להכניס לקרדיולוגיה , התער’, כירורגיה, אנדוקרינולוגיה
ומומלצים- אפשר להדגיש את היות המחקר ישראלי…

Bilateral internal thoracic artery grafting in diabetic patients: Short-term
and long-term results of a 515-patient series
Oren Lev-Ran, MDa,*, Rephael Mohr, MDa, Dmitri Pevni, MDa, Nahum Nesher,
MDa, Yona Weissman, BAb, Dan Loberman, MDa, Gideon Uretzky, MD

a Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center,
Tel Aviv, Israel,
b Statistical Service, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

Received for publication June 11, 2003; revisions received September 18,
2003; revisions received October 3, 2003; accepted for publication October
7, 2003. * Address for reprints: Oren Lev-Ran, MD, Department of Cardiac and
Thoracic Surgery, The Tel Aviv Sourasky Medical Center, 6 Weizman St, Tel
Aviv 64239, Israel

BACKGROUND: Despite potential long-term benefits, bilateral internal
thoracic artery grafting in diabetics remains controversial because of the
risk of sternal infection. We sought to assess the short- and long-term
outcome after left-sided bilateral internal thoracic artery grafting and to
determine the configuration of choice in diabetic subsets.

METHODS: Between 1996 and 2001, 515 diabetics underwent isolated left-sided
skeletonized bilateral internal thoracic artery grafting. The outcome of 468
consecutive oral-treated diabetics and 47 selective insulin-treated patients
was analyzed. Patients undergoing T-grafting were compared with those
undergoing in situ bilateral internal thoracic artery arrangements.

RESULTS: The respective rates for early mortality and sternal infections
were 2.4% and 1.9% in oral-treated diabetics and 6.3% and 4.3% in
insulin-treated diabetics. Multivariate correlates of sternal infection were
chronic lung disease (odds ratio, 10), obesity (odds ratio, 7), reoperation
(odds ratio, 22), and a creatinine level of 2 mg/dL or more (odds ratio, 8).
Five-year survival was 82%. The T-graft (n = 437) and in situ (n = 162)
subgroups had comparable baseline profiles. Freedom from cardiac mortality
at 6.5 years was 95.6% and 87.6% (P = .277), and freedom from repeat
revascularization was 91.5% and 92.7% (P = .860), respectively. The choice
of bilateral internal thoracic artery configuration did not appear as a
correlate of mortality, cardiac mortality, or major adverse cardiac events.
Complementary right-sided gastroepiploic artery (hazard ratio, 0.36) and
sequential (hazard ratio, 0.55) grafting were identified as protective
factors against the occurrence of major adverse cardiac events.

CONCLUSIONS: Routine skeletonized bilateral internal thoracic artery
grafting can be implemented safely in oral-treated diabetics. This strategy
is associated with a favorable late cardiac outcome and is thus recommended.
Both left-sided bilateral internal thoracic artery configurations provide
comparable short- and long-term outcomes.

      J Am Coll Cardiol. 2004 Feb 18;43(4):557-64.
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