Once-Daily Versus Twice-Daily Enoxaparin Dosing: Balancing Bleeding and Clotting Risk for Patients With Venous Thromboembolism

Last Updated Friday, February 17th, 2017

A study published in the Journal of Thrombosis and Haemostasis found that once-daily treatment with the low-molecular-weight heparin enoxaparin was associated with fewer major bleeds than twice-daily treatment in patients with acute venous thromboembolism (VTE). However, less-frequent dosing was associated with a higher rate of VTE recurrence.

Javier Trujillo-Santos, MD, PhD, from the Hospital General Universitario Santa Lucía in Murcia, Spain, and authors compared 15- and 30-day rates of VTE recurrence, major bleeding, and death inpatients who received once-daily (n=944; 20%) or twice-daily (n=3,786; 80%) enoxaparin. Patients were enrolled in the international, prospective RIETE registry which, the authors noted, provided real-world data about patient outcomes.

During the first 15 days of treatment, once-daily enoxaparin was associated with more VTE recurrences (odds ratio [OR] = 1.79; 95% CI 0.55-5.88), fewer major bleeds (OR=0.42; 95% CI 0.17-1.08), and fewer deaths (OR=0.32; 95% CI 0.13-0.78), compared with twice-daily dosing. This trend continued at 30 days; once-daily enoxaparin was again associated with more VTE recurrences (OR=2.5; 95% CI 1.03-5.88), fewer major bleeds (OR=0.40; 95% CI 0.17-0.94), and fewer deaths (OR=0.58; 95% CI 0.33-1.00), compared with twice-daily dosing.

Findings held when adjusted for confounding variables:

  • major bleeding: hazard ratio [HR] = 0.30 (95% CI 0.10-0.88) at 15 days and HR=0.16 (95% CI 0.04-0.68) at 30 days
  • deaths: HR=0.37 (95% CI 0.14-0.99) at 15 days and HR=0.19 (95% CI 0.07-0.54) at 30 days

Dr. Trujillo-Santos and colleagues noted several potential limitations, including the potential for selection bias in prospective registry studies and that the REITE registry did not collect information about factors that may have predisposed patients to death (i.e., duration of VTE symptoms prior to treatment initiation).

Source: Trujillo-Santos J, Bergmann JF, Cristiano B, et al. Once- versus twice daily enoxaparin for the initial treatment of acute venous thromboembolism. J Thromb Haemost. 2017 January 25. [Epub ahead of print]

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