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Factors that may cause Bleeding with Enoxaparin Ohoud M. Alarfaj, Hisham S. Abou-Auda, Ahmad Al-Barraq, Mohammad H. Daba. Methodology Objective To determine the factors that may affect LMWH such as (weight, renal function, drugs and disease). and to check if there is any Bleeding & Number of drugs • A retrospective trial, conducted in King Khalid correlation between occurrence of bleeding and these factors among University Hospital (KKUH) including 400 patients patients receiving LMWH. (178 male and 222 female). • A special data collection form was used. Introduction Drugs Bleeding (%) Aspirin 44 (46.8 %) Warfarin Diclofenac Ibuprofen Clopidogril Digoxin 23 19 14 13 5 N0. of drugs 0 1 2 3 4 (24.5 %) (20.2 %) (14.9 %) (13.8 %) (5.3 %) Bleeding (%) 26.6% 22.8% 22.2% 20.0% 42.6% • Enoxaparin is in a class of medications called low molecular Bleeding & Number of diseases weight heparins (LMWH). • In 1982 Kakkar et al was the first one who evaluates LMWH in Results humans. • LMWH is a class of medication used as an anticoagulant in diseases that cause thrombosis, as well as prophylaxis in Bleeding & Weight situations that lead to a high risk of thrombosis. • Used for several days after hip or knee replacement surgery , and 49 % in some cases following abdominal surgery, also patients who Normal unable to walk. Underweight • Due to the hydrophilic disposition of enoxaparin, accumulation is risk of hemorrhagic complications if standard weight adjusted Overweight 22 % 27 % treatment doses are used. • Obesity is a world wide health problem that is highly correlated Bleeding (%) N0. of disease Bleeding (%) 39 (41.5 %) 40 (42.6 %) 5 ( 5.3 % ) 19 (20.2 %) 9 (20.2 %) 19 (20.2 %) 2 ( 2.1 % ) 0 1 2 3 4 17.4% 28.4% 23.6% 24.6% 40.0% 2% Obese likely in patients with renal dysfunction thereby increasing the Disease HTN DM Heart Failure Pregnancy Renal Failure IHD CAD Bleeding & Renal Function Conclusion There is an increase in bleeding episode in patients with renal failure (P=0.012) than patients with normal renal function. The with morbidity and mortality from many disease. Obesity define risk of bleeding increase by almost two times with increase BMI according to WHO is a body mass index (BMI)≥30 kg/m² (≥30). There is also increasing in the risk of bleeding when • Enoxaparin treatment doses are calculated in terms of actual 20.5 % 25.4 % 42.9 % warfarin, diclofenac, ibuprofen and clopidogril. In addition there patient weight, but, because the drug is not distributed in fat, there is an increase in bleeding with increse no. of diseases (P=0.043). is a possibility of excessive drug exposure in obese patients. LMWHs have many adverse effects and the main one is bleeding. patients receive enoxaparin with more than one drugs of aspirin, Normal 258 Moderate 114 Failure 28