PMID- 19685350
OWN - NLM
STAT- MEDLINE
DCOM- 20090923
LR  - 20221212
IS  - 1424-7860 (Print)
IS  - 0036-7672 (Linking)
VI  - 139
IP  - 31-32
DP  - 2009 Aug 8
TI  - Low-molecular-weight heparin in patients with renal insufficiency.
PG  - 438-52
AB  - BACKGROUND: Low-molecular-weight heparins (LMWH) have been shown to be safer, 
      more effective and more convenient than unfractionated heparin (UFH) in many 
      clinical situations. However, their use is limited in patients with renal 
      insufficiency (RI) due to bioaccumulation. METHOD: The literature is critically 
      reviewed and known pharmacokinetic properties are summarised. An approach to 
      using LMWH in patients with RI is proposed on the basis of currently available 
      evidence. RESULTS AND DISCUSSION: Pharmacokinetic data of commonly used LMWH and 
      of UFH are summarised in respect of RI. Most data are known on enoxaparin. A dose 
      reduction is recommended in patients with severe RI. Limited data on dalteparin 
      and tinzaparin suggest that there is less bioaccumulation. However, further 
      studies are needed, in respect of long-term use and clinical end-points in 
      particular.There are no data on certoparin and only very limited data on 
      nadroparin. A detailed approach is suggested for the use of LMWH in patients with 
      severe RI. Briefly: (1) before using LMWH, evaluate the patient's renal function, 
      ist expected course, imminent interventions, and general bleeding risk; (2) 
      prefer LMWH to UFH in view of better efficacy and lower bleeding risk in general; 
      (3) however, prefer i.v. UFH to s.c. LMWH if a patient is unstable, is awaiting 
      emergency interventions, or has a high bleeding risk, since UFH can be stopped 
      more quickly due to i.v. administration, has a shorter half-life time, and can be 
      effectively antagonised; (4) prefer a well documented LMWH; use established 
      dosing schemes; (5) monitor LMWH with peak anti-Xa levels in patients with severe 
      RI regularly, and adjust dose to be in target range; (6) do not use LMWH in 
      patients with severe RI if there is no possibility of measuring anti-Xa levels. 
      CONCLUSIONS: LMWH may be considered for patients with severe RI. However, 
      experience, judicious choice and careful monitoring of patients with severe RI 
      treated with LMWH are necessary.
FAU - Schmid, Pirmin
AU  - Schmid P
AD  - Division of Haematology and Central Haematology Laboratory, Department of 
      Medicine, Kantonsspital Luzern, Luzern, Switzerland.
FAU - Fischer, Andreas G
AU  - Fischer AG
FAU - Wuillemin, Walter A
AU  - Wuillemin WA
LA  - eng
PT  - Journal Article
PT  - Review
PL  - Switzerland
TA  - Swiss Med Wkly
JT  - Swiss medical weekly
JID - 100970884
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
CIN - Swiss Med Wkly. 2009 Oct 31;139(43-44):642. PMID: 19950027
CIN - Swiss Med Wkly. 2010 Feb 20;140(7-8):122-3; author reply 123. PMID: 20175001
MH  - Anticoagulants/administration & dosage/adverse effects/*pharmacokinetics
MH  - Heparin, Low-Molecular-Weight/administration & dosage/adverse 
      effects/*pharmacokinetics
MH  - Humans
MH  - Kidney/drug effects/physiopathology
MH  - Renal Insufficiency/*metabolism/physiopathology
RF  - 120
EDAT- 2009/08/18 09:00
MHDA- 2009/09/24 06:00
CRDT- 2009/08/18 09:00
PHST- 2009/08/18 09:00 [entrez]
PHST- 2009/08/18 09:00 [pubmed]
PHST- 2009/09/24 06:00 [medline]
AID - smw-11284 [pii]
AID - 10.4414/smw.2009.11284 [doi]
PST - ppublish
SO  - Swiss Med Wkly. 2009 Aug 8;139(31-32):438-52. doi: 10.4414/smw.2009.11284.