Prospective observational cohort study of bioaccumulation of dalteparin at a prophylactic dose in patients with peritoneal dialysis

Schmid, Pirmin; Brodmann, Doreen; Fischer, Andreas; Wuillemin, Walter A.

doi:10.1111/j.1538-7836.2010.03749.x

Cited by 2 publications

(3 citation statements)

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“…Most of these studies were excluded from this review as they included a single bolus administration, a therapeutic dosage, or no anti-Xa activity measuring at multiple days. Dalteparin showed accumulation in hemodialysis patients if prescribed in a therapeutic dosage, but not in a prophylactic dosage, whereas accumulation was found for prophylactic dosage in peritoneal dialysis patients [ 19 , 40 , 52 ]. Prophylactic dosages of enoxaparin and prophylactic and therapeutic dosages of nadroparin showed no accumulation in hemodialysis and CVVH patients [ 40 , 41 , 53 , 54 ].…”

Section: Discussionmentioning

confidence: 99%

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A systematic review on the accumulation of prophylactic dosages of low-molecular-weight heparins (LMWHs) in patients with renal insufficiency

Atiq

Bemt

Leebeek

et al. 2015

Eur J Clin Pharmacol

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PurposeAlthough therapeutic dosages of most low-molecular-weight heparins (LMWHs) are known to accumulate in patients with renal insufficiency, for the lower prophylactic dosages this has not been clearly proven. Nevertheless, dose reduction is often recommended. We conducted a systematic review to investigate whether prophylactic dosages of LMWH accumulate in renal insufficient patients.MethodsA comprehensive search was conducted on 17 February 2015 using Embase, Medline, Web of Science, Scopus, Cochrane, PubMed publisher, and Google scholar. The syntax emphasized for LMWHs, impaired renal function, and pharmacokinetics. The search yielded 674 publications. After exclusion by reading the titles, abstracts, and if necessary the full paper, 11 publications remained.ResultsFor dalteparin and tinzaparin, no accumulation was observed. Enoxaparin, on the other hand, did lead to accumulation in patients with renal insufficiency, although not in patients undergoing renal replacement therapy. Bemiparin and certoparin also did show accumulation. No data were available for nadroparin.ConclusionsIn this systematic review, we show that prophylactic dosages of tinzaparin and dalteparin are likely to be safe in patients with renal insufficiency and do not need dose reduction based on the absence of accumulation. However, prophylactic dosages of enoxaparin, bemiparin, and certoparin did show accumulation in patients with a creatinine clearance (CrCl) below 30 ml/min, and therefore, dose reduction is required. The differences in occurrence of accumulation seem to depend on the mean molecular weight of LMWHs.Electronic supplementary materialThe online version of this article (doi:10.1007/s00228-015-1880-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

“…Since LMWHs are mainly excreted by the kidney, they may accumulate in patients with renal insufficiency increasing the risk of bleeding [ 17 – 19 ]. Due to above-described differences in pharmacokinetics, data on accumulation in renal insufficiency cannot be easily converted from one LMWH to another [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

A systematic review on the accumulation of prophylactic dosages of low-molecular-weight heparins (LMWHs) in patients with renal insufficiency

Atiq

Bemt

Leebeek

et al. 2015

Eur J Clin Pharmacol

View full text Add to dashboard Cite

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“…These doses are avoided in patients with severe renal dysfunction , which we define as either creatinine clearance (CrCl) <30 mL/min without dialysis dependence, or dialysis-dependent end-stage renal disease (ESRD) [ 7 , 8 ]. On the other hand, in such patients who receive prophylactic-dose LMWH (e.g., dalteparin 5000 IU daily), there is evidence from small observational studies of no bioaccumulation when such low-dose regimens are used for 7–10 days [ 9 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

Low-molecular-weight heparin venous thromboprophylaxis in critically ill patients with renal dysfunction: A subgroup analysis of the PROTECT trial

et al. 2018

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IntroductionThere is concern about excessive bleeding when low-molecular-weight heparins (LMWHs) are used for venous thromboembolism (VTE) prophylaxis in renal dysfunction. Our objective was to evaluate whether LMWH VTE prophylaxis was safe and effective in critically ill patients with renal dysfunction by conducting a subgroup analysis of PROTECT, a randomized blinded trial.MethodsWe studied intensive care unit (ICU) patients with pre-ICU dialysis-dependent end-stage renal disease (ESRD; pre-specified subgroup; n = 118), or severe renal dysfunction at ICU admission (defined as ESRD or non-dialysis dependent with creatinine clearance [CrCl] <30 ml/min; post hoc subgroup; n = 590). We compared dalteparin, 5000 IU daily, with unfractionated heparin (UFH), 5000 IU twice daily, and considered outcomes of proximal leg deep vein thrombosis (DVT); pulmonary embolism (PE); any VTE; and major bleeding. Adjusted hazard ratios [HR] were calculated using Cox regression.ResultsIn patients with ESRD, there was no significant difference in DVT (8.3% vs. 5.2%, p = 0.76), any VTE (10.0% vs. 6.9%; p = 0.39) or major bleeding (5.0% vs. 8.6%; p = 0.32) between UFH and dalteparin. In patients with severe renal dysfunction, there was no significant difference in any VTE (10.0% vs. 6.4%; p = 0.07) or major bleeding (8.9% vs. 11.0%; p = 0.66) but an increase in DVT with dalteparin (7.6% vs. 3.7%; p = 0.04). Interaction p-values for comparisons of HRs (ESRD versus not) were non-significant.ConclusionsIn critically ill patients with ESRD, or severe renal dysfunction, there was no significant difference in any VTE or major bleeding between UFH and dalteparin. Patients with severe renal dysfunction who received dalteparin had more proximal DVTs than those on UFH; this finding did not hold in patients with ESRD alone.

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Prospective observational cohort study of bioaccumulation of dalteparin at a prophylactic dose in patients with peritoneal dialysis

Cited by 2 publications

References 10 publications

A systematic review on the accumulation of prophylactic dosages of low-molecular-weight heparins (LMWHs) in patients with renal insufficiency

A systematic review on the accumulation of prophylactic dosages of low-molecular-weight heparins (LMWHs) in patients with renal insufficiency

Low-molecular-weight heparin venous thromboprophylaxis in critically ill patients with renal dysfunction: A subgroup analysis of the PROTECT trial

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