Subcutaneous Enoxaparin for Therapeutic Anticoagulation in Hemodialysis Patients

Pon, Tiffany; Dager, William E.; Roberts, A. Joshua; White, Richard

doi:10.1016/j.thromres.2014.03.036

Cited by 22 publications

(20 citation statements)

References 25 publications

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“…Safety and potential superiority of subcutaneously administered LMWH compared to intravenous UFH have also been described for therapeutic anticoagulation . Additionally, safety and efficacy of LMWH have been demonstrated in the setting of anticoagulation for extracorporeal circuits, namely renal replacement therapy . At our institution, LMWH has been the preferred substance for anticoagulation of ECMO patients for more than eight years.…”

Section: Discussionmentioning

confidence: 95%

Low molecular weight heparin versus unfractioned heparin for anticoagulation during perioperative extracorporeal membrane oxygenation: A single center experience in 102 lung transplant patients

et al. 2020

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Extracorporeal membrane oxygenation (ECMO) is gaining importance in the perioperative management of lung transplant patients. To date, the ideal substance for anticoagulation of ECMO patients is still a matter of debate. In this study, we describe our experience with the use of low molecular weight heparin (LMWH) in comparison with unfractioned heparin (UFH) in lung transplant patients undergoing perioperative ECMO support. We retrospectively analyzed data from all lung transplant patients who underwent perioperative ECMO support at our institution between 2013 and 2017. Bleeding events served as primary outcome parameter. Secondary outcome parameters consisted of thromboembolic events. 102 patients were included in this study, of which 22 (21.6%) received UFH for anticoagulation, and 80 (78.4%) received LMWH. There was no difference between the two groups in regard to serious bleeding events (22.7% in the UFH group vs 12.5% in the LMWH group, P = .31). However, the proportion of patients experiencing thromboembolic events was significantly higher in the UFH group than in the LMWH group (50% vs 20%, P = .01). After adjusting for baseline differences between the two groups, we still observed a difference with respect to thromboembolic events. These data remain to be validated in future prospective, randomized trials.

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Section: Discussionmentioning

confidence: 95%

Low molecular weight heparin versus unfractioned heparin for anticoagulation during perioperative extracorporeal membrane oxygenation: A single center experience in 102 lung transplant patients

et al. 2020

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“…However, other important uses are in acute coronary syndromes (Howard et al, 2014), extracorporeal circuitry (Lim et al, 2004;Sonawane et al, 2006;Cronin and Reilly, 2010;Davenport, 2011;Pon et al, 2014), and maintenance of the patency of indwelling catheters Kordzadeh et al, 2014). It should be noted that LMWH preparations differ in their characteristics (Hovanessian 1999;Hirsh et al, 2001;Gray et al, 2008;Garcia et al, 2012;Guerrini and Bisio, 2012); hence, their clinical effects cannot be expected to be identical or interchangeable.…”

Section: Clinical Use As An Anticoagulant/ Antithromboticmentioning

confidence: 99%

Pharmacology of Heparin and Related Drugs

et al. 2015

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“…Another study of 164 HD in-patients (including a subgroup of acute kidney injury patients treated with temporary HD) evaluated subcutaneous enoxaparin (average dose 0.7 ± 0.2 mg/kg/day) versus intravenous continuous UFH for therapeutic anticoagulation. 12 Yet again, there was no difference in major bleeding (6.1% vs 11%, P = 0.4) or thromboembolism (0% vs 2.4%, P = 0.5). None of the above studies monitored LMWH TA B L E 2 Pharmacologic properties and dosing recommendations in renal dysfunction and hemodialysis for three most widely used low molecular weight heparins (enoxaparin, tinzaparin, dalteparin)…”

Section: Challenges Of Heparinization Therapymentioning

confidence: 78%

“…No difference was found with regard to serious bleeding (risk ratio: 0.98; 95% CI 0.78 to 1.23) or venous thromboembolism (risk ratio: 0.77; 95% CI 0.49 to 1.22). Another study of 164 HD in‐patients (including a subgroup of acute kidney injury patients treated with temporary HD) evaluated subcutaneous enoxaparin (average dose 0.7 ± 0.2 mg/kg/day) versus intravenous continuous UFH for therapeutic anticoagulation . Yet again, there was no difference in major bleeding (6.1% vs 11%, P = 0.4) or thromboembolism (0% vs 2.4%, P = 0.5).…”

Section: Challenges Of Heparinization Therapymentioning

confidence: 99%

Antithrombotic medications in dialysis patients: a double‐edged sword

Vlachopanos

Ghalli

2017

J Evidence Based Medicine

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In the clinical context of end-stage renal disease (ESRD), thrombosis and bleeding risks are simultaneously increased and may have devastating consequences. While anticoagulant and antiplatelet drugs are indispensable for the prevention of thromboembolic events, the significantly higher bleeding risk makes their handling extremely complicated. In ESRD, they are frequently administered for a wide array of conditions. For example, atrial fibrillation is quite common in ESRD and warrants the use of anticoagulants like warfarin. Unfractionated heparin and low molecular weight heparins are typically used for clotting prevention in the hemodialysis extracorporeal circuit. The antithrombotics use dilemma has worsened because ESRD patients have been excluded from major clinical trials that defined standard indications, contraindications and optimal management of these medications. That limits our knowledge and results in that the process of decision-making depends on weaker data. Besides the substantial bleeding risk, warfarin may also increase cardiovascular risk because it is implicated in the pathogenesis of vascular calcifications in ESRD. The present article attempts to offer a comprehensive overview of practical considerations for the use of the most common antithrombotic medications in ESRD linking them, at the same time, to the best available evidence from randomized controlled trials and observational studies.

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Subcutaneous Enoxaparin for Therapeutic Anticoagulation in Hemodialysis Patients

Cited by 22 publications

References 25 publications

Low molecular weight heparin versus unfractioned heparin for anticoagulation during perioperative extracorporeal membrane oxygenation: A single center experience in 102 lung transplant patients

Low molecular weight heparin versus unfractioned heparin for anticoagulation during perioperative extracorporeal membrane oxygenation: A single center experience in 102 lung transplant patients

Pharmacology of Heparin and Related Drugs

Antithrombotic medications in dialysis patients: a double‐edged sword

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