Comparative effectiveness of enoxaparin versus unfractionated heparin for 30- and 90-day mortality in sepsis patients without severe renal dysfunction: a retrospective cohort study
- 1School of Public Health, Gansu University of Traditional Chinese Medicine, Lanzhou, China
- 2Department of Clinical Laboratory, China-Japan Friendship Hospital, Beijing, China
- 3Department of Infectious Diseases, China-Japan Friendship Hospital, Beijing, China
Abstract
BackgroundAlthough enoxaparin is known to be superior to UFH for thromboprophylaxis, the comparative effect of enoxaparin versus UFH on mortality in sepsis remains unknown. To address this gap, we compared the two agents in sepsis patients without severe renal impairment, thereby minimizing confounding due to differential drug clearance.MethodsIn this retrospective cohort study, we analyzed data from the eICU Collaborative Research Database. We included adult patients with sepsis and no severe renal impairment (eGFR ≥ 30 mL/min/1.73 m2) who received prophylactic anticoagulation with either enoxaparin or UFH. The primary outcomes were 30-day ICU mortality and 90-day in-hospital mortality. Survival analyses were performed using Kaplan–Meier estimates and Cox proportional hazards models. Sensitivity analyses were conducted using inverse probability of treatment weighting.ResultsA total of 2,341 patients were enrolled (1,260 in the enoxaparin group and 1,081 in the UFH group). After adjusting for confounders, multivariate Cox regression showed that the hazard ratio (HR) for enoxaparin versus UFH was 0.94 (95% CI: 0.67–1.32, P = 0.726) for 30-day ICU mortality and 0.86 (95% CI: 0.66–1.12, P = 0.271) for 90-day in-hospital mortality. Subgroup analyses showed no significant heterogeneity across predefined strata of age, sex, or BMI (all P for interaction >0.05). These findings were supported by inverse probability of treatment weighting analysis.ConclusionsIn this cohort of sepsis patients without severe renal impairment, enoxaparin was associated with numerically lower but not statistically significant hazard ratios for both 30-day ICU and 90-day in-hospital mortality compared with UFH. These findings do not establish the superiority of either agent. Larger, prospective studies are warranted to confirm the observed associations.
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BibTeX
@article{xue2026comparative,
title = {{Comparative effectiveness of enoxaparin versus unfractionated heparin for 30- and 90-day mortality in sepsis patients without severe renal dysfunction: a retrospective cohort study}},
author = {Zhe Xue and Zhe Xue and Rubing Guo and Rubing Guo and Xiaolin Lou and Xiaolin Lou and Yuanshu Tian and Yuanshu Tian and Jingjing Tong and Wei Zhao},
journal = {Frontiers in Medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1886512},
url = {https://doi.org/10.3389/fmed.2026.1886512},
note = {CC BY},
}
RIS
TY - JOUR
TI - Comparative effectiveness of enoxaparin versus unfractionated heparin for 30- and 90-day mortality in sepsis patients without severe renal dysfunction: a retrospective cohort study
AU - Zhe Xue
AU - Zhe Xue
AU - Rubing Guo
AU - Rubing Guo
AU - Xiaolin Lou
AU - Xiaolin Lou
AU - Yuanshu Tian
AU - Yuanshu Tian
AU - Jingjing Tong
AU - Wei Zhao
PY - 2026
DA - 2026/10/26
JO - Frontiers in Medicine
DO - 10.3389/fmed.2026.1886512
UR - https://doi.org/10.3389/fmed.2026.1886512
AB - BackgroundAlthough enoxaparin is known to be superior to UFH for thromboprophylaxis, the comparative effect of enoxaparin versus UFH on mortality in sepsis remains unknown. To address this gap, we compared the two agents in sepsis patients without severe renal impairment, thereby minimizing confounding due to differential drug clearance.MethodsIn this retrospective cohort study, we analyzed data from the eICU Collaborative Research Database. We included adult patients with sepsis and no severe renal impairment (eGFR ≥ 30 mL/min/1.73 m2) who received prophylactic anticoagulation with either enoxaparin or UFH. The primary outcomes were 30-day ICU mortality and 90-day in-hospital mortality. Survival analyses were performed using Kaplan–Meier estimates and Cox proportional hazards models. Sensitivity analyses were conducted using inverse probability of treatment weighting.ResultsA total of 2,341 patients were enrolled (1,260 in the enoxaparin group and 1,081 in the UFH group). After adjusting for confounders, multivariate Cox regression showed that the hazard ratio (HR) for enoxaparin versus UFH was 0.94 (95% CI: 0.67–1.32, P = 0.726) for 30-day ICU mortality and 0.86 (95% CI: 0.66–1.12, P = 0.271) for 90-day in-hospital mortality. Subgroup analyses showed no significant heterogeneity across predefined strata of age, sex, or BMI (all P for interaction >0.05). These findings were supported by inverse probability of treatment weighting analysis.ConclusionsIn this cohort of sepsis patients without severe renal impairment, enoxaparin was associated with numerically lower but not statistically significant hazard ratios for both 30-day ICU and 90-day in-hospital mortality compared with UFH. These findings do not establish the superiority of either agent. Larger, prospective studies are warranted to confirm the observed associations.
SN - 2296-858X
ER -