Is Impaired Renal Function a Contraindication to the Use of Low-Molecular-Weight Heparin?

Nagge, Jeff; Crowther, Mark; Hirsh, Jack

doi:10.1001/archinte.162.22.2605

Cited by 124 publications

(67 citation statements)

References 15 publications

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“…9 Supporting the use of anti-factor Xa monitoring in patients with renal failure is the different potential for accumulation among the various LMWH preparations and the absence of a clear threshold of creatinine clearance for identification of patients at increased risk for accumulation. 41 Obese patients have been under-represented in treatment trials using LMWH, and although individual LMWH preparations have shown predictable antifactor Xa levels in this patient group, 42,43 measuring levels on at least 1 occasion seems prudent.…”

Section: Comparative Efficacy and Safety Of Ufh And Lmwhmentioning

confidence: 99%

Initial Treatment of Venous Thromboembolism

McRae

Ginsberg

2004

Circulation

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Abstract-Adequate initial anticoagulant therapy of deep venous thrombosis (DVT) is required to prevent thrombus growth and pulmonary embolism (PE). Intravenous unfractionated heparin (UFH) is being replaced by low-molecular-weight heparin (LMWH) as the anticoagulant of choice for initial treatment of venous thromboembolism (VTE). Both agents are relatively safe and effective when used to treat VTE, with LMWH suitable for outpatient therapy because of improved bioavailability and more predictable anticoagulant response. Serious potential complications of heparin therapy, such as heparin-induced thrombocytopenia (HIT) and osteoporosis, seem less common with LMWH. The potential for fetal harm and changes in maternal physiology complicate the treatment of VTE during pregnancy. Although systemic thrombolysis is used in patients with massive PE and in some patients with proximal DVT, controversy persists with respect to appropriate patient selection for this intervention. Key Words: venous thromboembolism Ⅲ pulmonary embolism Ⅲ deep venous thrombosis Ⅲ anticoagulants Ⅲ thrombosis Ⅲ heparin

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Section: Comparative Efficacy and Safety Of Ufh And Lmwhmentioning

confidence: 99%

Initial Treatment of Venous Thromboembolism

McRae

Ginsberg

2004

Circulation

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“…A creatinine clearance threshold of 30 ml/min is frequently used to identify patients who may be at increased risk for bioaccumulation and bleeding, although there is no evidence to support this threshold (7). It is understandable, then, that clinical use of LMWH in patients with renal failure has been inconsistent; when used therapeutically, there is variable reliance on monitoring with anti-Xa levels and variable empiric dose adjustments.…”

mentioning

confidence: 99%

Safety and Efficacy of Low Molecular Weight Heparins for Hemodialysis in Patients with End-Stage Renal Failure

Lim¹,

Cook²,

Crowther³

2004

Journal of the American Society of Nephrology

154

128

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Abstract. Low molecular weight heparins (LWMH) are the preferred initial treatment for many thromboembolic disorders but are renally excreted and relatively contraindicated in patients with renal failure because of concerns of increased bleeding risks. The purpose of this study was to evaluate the safety and efficacy of LMWH compared with unfractionated heparin (UFH) for preventing thrombosis of the extracorporeal dialysis circuit. Studies were identified with the use of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and FirstSearch; reference lists were reviewed; and pharmaceutical companies were contacted. Randomized, controlled trials that compared an LMWH with another anticoagulant during hemodialysis in patients with ESRD and reported at least one of bleeding, extracorporeal circuit thrombosis, or anti-Xa levels were chosen. Two reviewers independently extracted data on methodologic quality, study design, clinical outcomes, and anti-Xa levels. Seventeen trials were included in this systematic review, 11 of which were included in the meta-analysis. It was found that LMWH did not significantly affect the number of bleeding events (relative risk, 0.96; 95% confidence interval [CI], 0.27 to 3.43), bleeding assessed by vascular access compression time (weighted mean difference, Ϫ0.87; 95% CI, Ϫ2.75 to 1.02), or extracorporeal circuit thrombosis (relative risk, 1.15; 95% CI, 0.70 to 1.91) as compared with UFH.

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“…Renal failure with GFR <30 ml/min limits the use of LMWH, since these drugs depend on renal clearance for drug elimination and increased blood levels increase the risk of bleeding. 47 Whether the occurrence of thromboembolic complications is associated with increased mortality in multiple myeloma is still controversial. Shorter survival was reported in patients with early thrombotic events (within 6 months after start of initial therapy 43 or within the first 2 years 44 ) while in another study 45 no difference in mortality was noted, neither in newly diagnosed nor in relapsed/refractory myeloma.…”

Section: Thromboembolic Complicationsmentioning

confidence: 99%

Prevention and management of adverse events of Novel agents in multiple myeloma: A consensus of the european myeloma network

Ludwig

Delforge²,

Facon

et al. 2017

Leukemia

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During the last few years, several new drugs have been introduced for treatment of patients with multiple myeloma, which have significantly improved treatment outcome. All of these novel substances differ at least in part in their mode of action from similar drugs of the same drug class, or are representatives of new drugs classes, and as such present with very specific side effect profiles. In this review, we summarize these adverse events, provide information on their prevention, and give practical guidance for monitoring of patients and for management of adverse events.

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Is Impaired Renal Function a Contraindication to the Use of Low-Molecular-Weight Heparin?

Abstract: The use of a 30-mL/min (0.50-mL/s) cutoff is not justified, on the basis of currently available evidence, to select individuals at increased risk of accumulation when LMW heparin is used. The pharmacokinetic response to impaired renal function may differ among LMW heparin preparations.

Cited by 124 publications

References 15 publications

Initial Treatment of Venous Thromboembolism

Initial Treatment of Venous Thromboembolism

Safety and Efficacy of Low Molecular Weight Heparins for Hemodialysis in Patients with End-Stage Renal Failure

Prevention and management of adverse events of Novel agents in multiple myeloma: A consensus of the european myeloma network

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