Study of bioaccumulation of dalteparin at a prophylactic dose in patients with various degrees of impaired renal function

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

doi:10.1111/j.1538-7836.2009.03292.x

Cited by 24 publications

(25 citation statements)

References 29 publications

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“…Tincani showed that no bioaccumulation occurred after 6 days of dalteparin prophylaxis, irrespective of renal function without major bleeding events. 28 Studies performed by both Schmid et al and Shprecher et al showed no increase in anti-factor Xa level in patients with renal impairment in prophylactic or therapeutic dosing, 10,29 and a metaanalysis from 2006 notes that insufficient data exist to assess risk for major bleeding for other LMWHs such as dalteparin and tinzaparin, while still advising adjusted dose enoxaparin in CKD. 30 Strengths.…”

Section: Discussionmentioning

confidence: 99%

Treatment with Dalteparin is Associated with a Lower Risk of Bleeding Compared to Treatment with Unfractionated Heparin in Patients with Renal Insufficiency

et al. 2015

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BACKGROUND: Low molecular weight heparins (LMWHs) have been cautiously used in patients with chronic kidney disease (CKD) due to fear of accumulation. Dalteparin, however, has shown minimal tendency to accumulate in patients with CKD and may be safe to use in this patient population. OBJECTIVE: We compared the incidence of clinically significant bleeding in patients with CKD receiving therapeutic doses of dalteparin to that of patients with CKD receiving therapeutic doses of UFH. DESIGN: This was a retrospective cohort study. SUBJECTS: Inpatients with CKD (GFR<60 ml/min) who were treated with therapeutic dalteparin or UFH were included in the study MAIN MEASURES: Primary outcome was major bleeding within 10 days of anticoagulation, identified by ICD-9 code and confirmed by chart review. Demographic characteristics, laboratory values, comorbidities, prior bleeding history and inpatient medications were extracted for each admission from the electronic medical record. Logistic regression models were created to examine the association between choice of anticoagulant and bleeding rates, after adjustment for demographic and clinical characteristics. KEY RESULTS: Dalteparin-treated patients were significantly less likely to experience a major bleed than patients treated with UFH (1.14 % vs. 3.49 %, p<0.001). The reduced likelihood of bleeding associated with dalteparin treatment remained significant after adjustment for patient characteristics (HR 0.39, 95 % CI: 0.21-0.70, p < 0.0001). A stratified analysis for subgroups with GFR< 30 mL/min and with GFR between 30 and 60 mL/min showed that dalteparin was still associated with lower odds of bleeding compared to treatment with unfractionated heparin, but the difference was nonsignificant for GFR< 30 (HR 0.35,), even after adjustment (OR 0.37, 95 % CI: 0.11-1.22). CONCLUSION: In patients with CKD, treatment with therapeutic dose dalteparin was associated with lower rates of bleeding than treatment with unfractionated heparin. For patients with severe CKD (GFR< 30), dalteparin was shown to be at least as safe as unfractionated heparin.KEY WORDS: dalteparin; renal insufficiency; bleed; heparin.

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Section: Discussionmentioning

confidence: 99%

Treatment with Dalteparin is Associated with a Lower Risk of Bleeding Compared to Treatment with Unfractionated Heparin in Patients with Renal Insufficiency

et al. 2015

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“…The relationship between renal impairment and drug accumulation for the various LMWHs appears to be variable and may be related to the chain length distribution of the different LMWH preparations (54). Two recent studies in hospitalized patients, the majority of whom were critically ill and had creatinine clearances less than 30 mL/min, have shown no bioaccumulation of dalteparin 5000 U once daily based on serial anti-factor Xa levels (55,56). Therefore, we do not reduce the prophylaxis dose of dalteparin in patients with renal insufficiency.…”

Section: Anticoagulant Use In Renal Insufficiencymentioning

confidence: 99%

Approaching Venous Thrombosis in General Surgery Patients

Hepgül¹,

Yanar²,

Küçükyılmaz³

2012

Venous Thrombosis - Principles and Practice

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“…3,4 In patients with severe renal impairment (creatinine clearance 15-30 mL/min; stage IV chronic kidney disease), LMWH dose reduction and anti-Xa monitoring should be performed. 5 For patients with stage V chronic kidney disease, intravenous unfractionated heparin should be used for this purpose. After warfarin discontinuation, a daily therapeutic dose of LMWH is initiated once the INR falls below the therapeutic range.…”

Section: Systematic Approach To Anticoagulantsmentioning

confidence: 99%