PMID- 17940486
OWN - NLM
STAT- MEDLINE
DCOM- 20071127
LR  - 20071017
IS  - 1070-5287 (Print)
IS  - 1070-5287 (Linking)
VI  - 13
IP  - 5
DP  - 2007 Sep
TI  - Low molecular weight heparin and bleeding in patients with chronic renal failure.
PG  - 409-13
AB  - PURPOSE OF REVIEW: Low molecular weight heparin (LMWH) has largely replaced 
      unfractionated heparin (UFH) in patients with venous thromboembolism because of 
      its pharmacokinetic profile, ease of administration and lack of need for 
      monitoring. The pharmacokinetic profile of LMWH is due to lower molecular weight 
      and reduced charge resulting in less nonspecific protein binding than UFH. These 
      same characteristics make LMWH more dependent on renal function compared with 
      UFH. Consequently, care should be employed when LMWH is administered to patients 
      with impaired renal function as reduced clearance and bioaccumulation may cause 
      bleeding. RECENT FINDINGS: LMWHs vary in their likelihood of bioaccumulation in 
      chronic renal failure. Enoxaparin bioaccumulates and causes bleeding if 
      administered in therapeutic doses without dose adjustment to patients with 
      impaired renal function. Less rigorous evidence suggests that tinzaparin does not 
      bioaccumulate. Bioaccumulation appears to be greatest in patients with a 
      creatinine clearance less than 30 ml/min, and when therapeutic LMWH doses are 
      used. SUMMARY: Care should be used when LMWHs are administered to patients with 
      impaired renal function, particularly those with severe impairment (creatinine 
      clearance below 30 ml/min).
FAU - Crowther, Mark
AU  - Crowther M
AD  - St. Joseph's Hospital, Hamilton, Ontario, Canada. crowthrm@mcmaster.ca
FAU - Lim, Wendy
AU  - Lim W
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Curr Opin Pulm Med
JT  - Current opinion in pulmonary medicine
JID - 9503765
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
MH  - Anticoagulants/*adverse effects/metabolism/therapeutic use
MH  - Hemorrhage/*chemically induced
MH  - Heparin, Low-Molecular-Weight/*adverse effects/metabolism/therapeutic use
MH  - Humans
MH  - Kidney/metabolism/physiopathology
MH  - Kidney Failure, Chronic/*complications/metabolism/physiopathology
MH  - Pulmonary Embolism/drug therapy
MH  - Venous Thrombosis/drug therapy
RF  - 15
EDAT- 2007/10/18 09:00
MHDA- 2007/12/06 09:00
CRDT- 2007/10/18 09:00
PHST- 2007/10/18 09:00 [pubmed]
PHST- 2007/12/06 09:00 [medline]
PHST- 2007/10/18 09:00 [entrez]
AID - 00063198-200709000-00012 [pii]
AID - 10.1097/MCP.0b013e328216430d [doi]
PST - ppublish
SO  - Curr Opin Pulm Med. 2007 Sep;13(5):409-13. doi: 10.1097/MCP.0b013e328216430d.