A controlled trial of low-molecular-weight heparin (dalteparin) versus unfractionated heparin as anticoagulant during continuous venovenous hemodialysis with filtration

Reeves, John H.; Cumming, Alison R.; Gallagher, Leanne; O’Brien, Jennifer L.; Santamaria, John

doi:10.1097/00003246-199910000-00026

Cited by 122 publications

(59 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…No major bleeding occurred, but 26% of the patients in the enoxaparin group had minor bleeding episodes. This finding differs from the report by Reeves et al 30 and by Joannidis et al 35 who found no difference in the prevalence of hemorrhagic complications between the two methods of anticoagulation.…”

Section: Enoxaparin Vs Unfractioned Heparin In Cvvhd 325contrasting

confidence: 99%

“…At 48 hours of CVVHD, platelet count and proportion of patients with thrombocytopenia were similar between enoxaparin and UFH groups in accordance with the data reported by Reeves et al 30 Nevertheless, in patients who presented bleeding, platelet levels tended to be lower. It is probable that thrombocytopenia in this context was associated more with severity of disease (sepsis and multiple organ dysfunction syndrome) than to an autoimmune effect induced by enoxaparin (heparin-induced thrombocytopenia), because it occurred earlier than 4 days and was not accompanied by thromboembolic events.…”

Section: Enoxaparin Vs Unfractioned Heparin In Cvvhd 325supporting

confidence: 90%

“…28,29 Another important limitation to the use of LMWH has been their high cost in relation to UFH. 7,30 LMWH has been more widely tested in chronic hemodialysis 7,31,32 with few clinical trials assessing their efficacy and safety in CRRT. Some were randomized and controlled, but in general these studies involved a small number of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Some were randomized and controlled, but in general these studies involved a small number of patients. 8,24,30,33,34 Three …”

Section: Discussionmentioning

confidence: 99%

“…40 In this context, it is important to emphasize the need to adjust LMWH dose in patients on CRRT based on anti-Xa activity, because with target levels of anti-Xa the incidence of bleeding complications decreases as reported by several authors. 11,15,[28][29][30][33][34][35]39 This was addressed by Lim et al in a recent meta-analysis 29 , showing that major bleeding was increased when standard doses of enoxaparin were used but did not increase with empirically adjusted doses. Even though enoxaparin dose was reduced on account of severe renal insufficiency, we recognize as a limitation of our study the use of enoxaparin in fixed doses of 40 mg not adjusted for patient weight, without monitoring and targeting the level of anti-factor Xa perhaps at less than 0.9 IU/mL.…”

Section: Enoxaparin Vs Unfractioned Heparin In Cvvhd 325mentioning

confidence: 99%

See 4 more Smart Citations

Enoxaparin versus unfractioned heparin as anticoagulant for continuous venovenous hemodialysis: a randomized open-label trial

et al. 2010

View full text Add to dashboard Cite

Aim: In this study we aimed to compare the efficacy and safety of enoxaparin with unfractioned heparin (UFH) as anticoagulant for continuous venovenous hemodialysis (CVVHD). Methods: An open-label randomized controlled trial was carried out in an intensive care unit (ICU) where 40 patients with acute renal failure (ARF) who needed continuous renal replacement therapy were randomized to receive UFH (n = 21) or enoxaparin (n = 19). Coagulation parameters were evaluated, and antithrombotic activity of UFH was measured by activated partial thromboplastin time (aPTT) and for enoxaparin by anti-factor Xa activity. Primary outcomes were thrombosis of the extracorporeal circuit and bleeding, classified as major or minor. Results: Minor bleeding episodes were observed only in patients anticoagulated with enoxaparin (26 vs. 0%, p = 0.018). Comparing patients with or without bleeding after 24 hours of therapy, the level of anticoagulation tended to be higher (anti-factor Xa: 1.62 vs. 1.13 IU/mL, p = 0.09) and the platelet count to be lower [107 ± 53 vs. 229 ± 84 (×10 3 /μL), p = 0.09] in patients who bled, but without statistical difference. Filter life span of enoxaparin and UFH groups was similar (43 ± 15 vs. 52 ± 18 hr, p = 0.10), as well as the proportion of circuit clotting. Conclusion: Weightunadjusted enoxaparin in patients with ARF in CVVHD was associated with an increased rate of bleeding, a finding that addresses the need to adjust drug dose and to monitor anti-factor Xa activity during dialysis. No benefit to prolong dialysis circuit survival was found with enoxaparin. In patients who do not present contraindication for systemic anticoagulation, UFH remains an effective and low-cost option.

show abstract

Section: Enoxaparin Vs Unfractioned Heparin In Cvvhd 325contrasting

confidence: 99%

Section: Enoxaparin Vs Unfractioned Heparin In Cvvhd 325supporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

“…Some were randomized and controlled, but in general these studies involved a small number of patients. 8,24,30,33,34 Three …”

Section: Discussionmentioning

confidence: 99%

Section: Enoxaparin Vs Unfractioned Heparin In Cvvhd 325mentioning

confidence: 99%

See 3 more Smart Citations

Enoxaparin versus unfractioned heparin as anticoagulant for continuous venovenous hemodialysis: a randomized open-label trial

et al. 2010

View full text Add to dashboard Cite

show abstract

Low-Molecular-Weight Heparin for Anticoagulation During Continuous Venovenous Hemofiltration—Reply

Knight¹,

Selwyn²,

Girling³

2003

Arch Intern Med

View full text Add to dashboard Cite

sumption, smoking, exercise, hypertension, diabetes, history of high cholesterol, history of angina, parental history of premature myocardial infarction, and randomized treatment assignment did not attenuate this estimate (relative risk, 1.24 [95% confidence interval, 0.80-1.92]). It is not entirely surprising that the effect estimate is somewhat smaller in the elderly because individuals with high BMIs have greater risks of cardiovascular events at a younger age and thus may die earlier. 2 Those who survive may be less susceptible to those events. In addition, the elderly have higher baseline risks of stroke and relative risks of even modest to moderate magnitude can translate into substantial differences in absolute risk.The combined evidence from our study and that of Milionis and colleagues suggests that excess weight may be an independent risk factor for ischemic stroke regardless of geographic location and lifestyle factors. Since the diet of participants in the 2 studies are different, the results also suggest that it does not matter how the excess weight was gained with respect to the association between BMI and ischemic stroke.

show abstract

Unfractionated heparin versus low molecular weight heparin for avoiding heparin-induced thrombocytopenia in postoperative patients

Junqueira¹,

Perini

Penholati

et al. 2012

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

There was a lower incidence of HIT and HIT complicated by VTE in postoperative patients undergoing thromboprophylaxis with LMWH compared with UFH. This is consistent with the current clinical use of LMWH over UFH as front-line heparin therapy. However, conclusions are limited by a scarcity of high quality evidence. We did not expect the paucity of RCTs including HIT as an outcome as heparin is one of the most commonly used drugs worldwide and HIT is a life-threatening adverse drug reaction. To address the scarcity of clinically-relevant information on the topic of HIT as a whole, HIT should be included as an outcome in future RCTs of heparin, and HIT as an adverse drug reaction should be considered in clinical recommendations regarding monitoring of the platelet count for HIT.

show abstract

A controlled trial of low-molecular-weight heparin (dalteparin) versus unfractionated heparin as anticoagulant during continuous venovenous hemodialysis with filtration

Abstract: Fixed-dose dalteparin provided identical filter life, comparable safety, but increased total daily cost compared with adjusted-dose heparin. Unfractionated heparin remains our anticoagulant of choice for continuous hemofiltration in intensive care.

Cited by 122 publications

References 14 publications

Enoxaparin versus unfractioned heparin as anticoagulant for continuous venovenous hemodialysis: a randomized open-label trial

Enoxaparin versus unfractioned heparin as anticoagulant for continuous venovenous hemodialysis: a randomized open-label trial

Low-Molecular-Weight Heparin for Anticoagulation During Continuous Venovenous Hemofiltration—Reply

Unfractionated heparin versus low molecular weight heparin for avoiding heparin-induced thrombocytopenia in postoperative patients

Contact Info

Product

Resources

About