PMID- 21132647
OWN - NLM
STAT- MEDLINE
DCOM- 20110304
LR  - 20141120
IS  - 0393-5590 (Print)
IS  - 0393-5590 (Linking)
VI  - 27
IP  - 6
DP  - 2010 Nov-Dec
TI  - [The risk of bleeding associated with low molecular weight heparin in patients 
      with renal failure].
PG  - 649-54
AB  - Cardiovascular mortality and morbidity are higher in patients with chronic renal 
      disease than in the general population. Patients with chronic renal disease are 
      in the highest risk group for thromboembolic disease and many clinical trials 
      have demonstrated the greater safety and efficacy of low-molecular-weight heparin 
      (LMWH) versus unfractionated heparin (UFH). LMWH is cleared only by the kidneys 
      while UFH is cleared by the renal and hepatic routes. Furthermore, LMWH has a 
      significant accumulative effect in patients with impaired renal function 
      (creatinine clearance <30 mL/min). The aim of this study was to evaluate the risk 
      of bleeding when LMWH is used as an anticoagulant in hemodialysis or for 
      treatment of acute thromboembolic disease in patients with renal failure. 
      Twenty-one adult patients were enrolled, 13 with end-stage renal disease 
      requiring chronic hemodialysis and 6 with acute thromboembolic disease and severe 
      renal insufficiency (creatinine clearance <30 mL/min). Group A consisted of 13 
      patients receiving LMWH (enoxaparin 60 IU/kg/day) for preventing thrombosis of 
      the extracorporeal dialysis circuit. Group B consisted of 8 patients with acute 
      thromboembolic disease receiving LMWH (enoxaparin 60 IU/kg/day). In all patients 
      anti-Xa activity was measured by a chromogenic assay (HEMONOX). In the first 
      group 2 blood samples were taken during the dialysis session (2-4 hours) and a 
      third sample after the end of the session up to 48 hours following enoxaparin 
      injection; in the second group a blood sample was taken 4 days after the start of 
      LMWH treatment, 2 hours after its daily administration. In group A, all dialysis 
      sessions were performed with no minor or major bleeding. Anti-Xa activity was 
      highest 2 hours after the start and remained above 100 seconds after the end of 
      the session, while 44 hours after injection, at the start of the next dialysis 
      session, it was low or absent (<100 seconds). In the second group there were 2 
      major bleeding episodes, 2 minor bleeding episodes, 1 prolonged time to 
      hemostasis after needle removal, and 2 bleeding episodes at the vascular access 
      site (central venous catheter). Anti-Xa activity was consistently higher than 200 
      seconds (therapeutic target range:100-200 seconds) and showed interindividual 
      variability (in 2 patients the anti-Xa time was more than 900 seconds), 
      indicating a high risk of bleeding. LMWH seems to be as effective and safe as UFH 
      in terms of bleeding complications and in preventing extracorporeal circuit 
      thrombosis in patients on hemodialysis. Our results indicate that it is 
      preferable to avoid invasive procedures for 12 hours following a dialysis session 
      performed with LMWH anticoagulation because the anticoagulant effect lasted at 
      least 4 hours after its injection. These data suggest that in patients with acute 
      thromboembolic events and severe renal insufficiency, standard anticoagulation 
      with LMWH is not recommended because of an increased risk of major and minor 
      bleeding.
FAU - Lai, Silvia
AU  - Lai S
AD  - Dipartimento di Nefrologia, Universita degli Studi, Roma, Italy. silvlai@tin.it
FAU - Barbano, Biagio
AU  - Barbano B
FAU - Cianci, Rosario
AU  - Cianci R
FAU - Gigante, Antonietta
AU  - Gigante A
FAU - Di Donato, Domenico
AU  - Di Donato D
FAU - Asllanaj, Bledian
AU  - Asllanaj B
FAU - Dimko, Mira
AU  - Dimko M
FAU - Mariotti, Amalia
AU  - Mariotti A
FAU - Morabito, Santo
AU  - Morabito S
FAU - Pugliese, Francesco
AU  - Pugliese F
LA  - ita
PT  - Comparative Study
PT  - English Abstract
PT  - Journal Article
TT  - Rischio emorragico nell'utilizzo di eparina a basso peso molecolare nel paziente 
      nefropatico?
PL  - Italy
TA  - G Ital Nefrol
JT  - Giornale italiano di nefrologia : organo ufficiale della Societa italiana di 
      nefrologia
JID - 9426434
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 0 (Factor Xa Inhibitors)
SB  - IM
MH  - Anticoagulants/administration & dosage/*adverse effects
MH  - Enoxaparin/administration & dosage/*adverse effects
MH  - Factor Xa Inhibitors
MH  - Female
MH  - Hemorrhage/*chemically induced/prevention & control
MH  - Humans
MH  - Kidney Failure, Chronic/therapy
MH  - Male
MH  - Middle Aged
MH  - Renal Dialysis/*adverse effects
MH  - Renal Insufficiency/*therapy
MH  - Risk
MH  - Thromboembolism/etiology/*prevention & control
EDAT- 2010/12/07 06:00
MHDA- 2011/03/05 06:00
CRDT- 2010/12/07 06:00
PHST- 2010/12/07 06:00 [entrez]
PHST- 2010/12/07 06:00 [pubmed]
PHST- 2011/03/05 06:00 [medline]
PST - ppublish
SO  - G Ital Nefrol. 2010 Nov-Dec;27(6):649-54.