肾功能不全 (RI) 癌症患者静脉血栓栓塞 (VTE) 的最佳治疗方法尚不清楚。目前的指南建议使用低分子量肝素而不是直接口服抗凝剂来治疗高出血风险癌症患者的 VTE。我们使用 RIETE 登记系统比较了以下方面的 6 个月发病率： 1) VTE 复发与严重流血的; 2) 接受依诺肝素单药治疗的癌症患者的 3 个亚组（轻度、中度或重度 RI）的致命性肺栓塞 (PE) 与致命性出血。从 2009 年 1 月到 2022 年 6 月，2,844 名 RI 患者接受依诺肝素≥6个月：1,432 人 (50%) 患有轻度 RI，1,168 人 (41%) 中度 RI，244 人 (8.6%) 患有重度 RI。总体而言，分别有 68%、62% 和 12% 的人接受了推荐剂量。在轻度 RI 患者中，VTE 复发率与大出血率（4.6% 对 5.4%）以及致命性 PE 与致命性出血率（1.3% 对 1.2%）相似。在中度 RI 患者中，VTE 复发率是大出血的一半（3.1% 对 6.3%），但致命性 PE 和致命性出血接近（1.8% 对 1.2%）。在严重 RI 患者中，VTE 复发的发生率比大出血少 3 倍（4.1% vs. 13%），但致命性 PE 的发生率比致命性出血高 3 倍（2.5% vs. 0.8%）。在前 10 天内，致命性 PE 的发生率是致命性出血的 5 倍（2.1% vs. 0.4%）。在患有严重 RI 的癌症患者中，致命性 PE 的发生率是致命性出血的 5 倍。应重新审视这些患者的依诺肝素推荐剂量。Thieme。版权所有。

The optimal therapy of venous thromboembolism (VTE) in cancer patients with renal insufficiency (RI) is unknown. Current guidelines recommend to use low-molecular-weight heparin over direct oral anticoagulants to treat VTE in cancer patients at high-risk for bleeding.We used the RIETE registry to compare the 6-month incidence rates of: 1) VTE recurrences vs. major bleeding; and 2) fatal pulmonary embolism (PE) vs. fatal bleeding in 3 subgroups (those with mild, moderate, or severe RI) of cancer patients receiving enoxaparin monotherapy.From January 2009 through June 2022, 2,844 patients with RI received enoxaparin for ≥6 months: 1,432 (50%) had mild, 1,168 (41%) moderate, and 244 (8.6%) had severe RI. Overall, 68%, 62% and 12% respectively, received the recommended doses. Among patients with mild RI, the rates of VTE recurrences vs. major bleeding (4.6% vs. 5.4%) and fatal PE vs. fatal bleeding (1.3% vs. 1.2%) were similar. Among patients with moderate RI, VTE recurrences were half as common as major bleeding (3.1% vs. 6.3%), but fatal PE and fatal bleeding were close (1.8% vs. 1.2%). Among patients with severe RI, VTE recurrences were 3-fold less common than major bleeding (4.1% vs. 13%), but fatal PE was 3-fold more frequent than fatal bleeding (2.5% vs. 0.8%). During the first 10 days, fatal PE was 5-fold more common than fatal bleeding (2.1% vs. 0.4%).Among cancer patients with severe RI, fatal PE was 5-fold more common than fatal bleeding. The recommended doses of enoxaparin in these patients should be revisited.Thieme. All rights reserved.