PARSIPPANY, N.J.— Orthopedic surgery patients with Stage 3B chronic kidney disease (CKD) are at high risk for blood clots despite standard treatment with the anticoagulant enoxaparin, according to a recently published study.

Blood clots and post-operative bleeding were reduced with use of desirudin, a new type of anticoagulant.

Results of the study, entitled “Impact Of Stage 3B Chronic Kidney Disease On Thrombosis And Bleeding Outcomes After Orthopedic Surgery In Patients Treated With Desirudin Or Enoxaparin: Insights From A Randomized Trial,” were published online ahead of print on June 4, 2012.

Desirudin, a direct thrombin inhibitor (DTI), works on a different part of the clotting system than enoxaparin. Desirudin is approved in the U.S. and Europe for the prevention of blood clots in patients undergoing orthopedic surgery. It is sold under the trade name Iprivask in the U.S. and Revasc in Europe. Desirudin, like enoxaparin, is administered by injection under the skin.

"The analysis indicates that patients with advanced kidney disease need to be approached differently when we consider issues of anticoagulation,” said Andrew Shorr, MD, Department of Pulmonary and Critical Care Medicine, Washington Hospital Center, Washington, DC, the study’s principal investigator. “The differential effects we observed between desirudin and enoxaparin demonstrate that a one-size-fits all strategy does not necessarily represent a careful balancing of risks and benefits.”

Major orthopedic surgery and advanced age are important risk factors for blood clots, which can be life-threatening. CKD is common in elderly patients undergoing orthopedic surgery and these patients have a four-fold increase in risk for blood clots as well as an increased risk for bleeding due to reduced elimination of anticoagulants. However, few studies have investigated anticoagulant performance in these high risk patients.

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