PMID- 28592259
OWN - NLM
STAT- MEDLINE
DCOM- 20180320
LR  - 20220330
IS  - 1471-2369 (Electronic)
IS  - 1471-2369 (Linking)
VI  - 18
IP  - 1
DP  - 2017 Jun 7
TI  - Safety of low-molecular-weight heparin compared to unfractionated heparin in 
      hemodialysis: a systematic review and meta-analysis.
PG  - 187
LID - 10.1186/s12882-017-0596-4 [doi]
LID - 187
AB  - BACKGROUND: Low molecular weight heparins (LMWH) have been extensively studied 
      and became the treatment of choice for several indications including pulmonary 
      embolism. While their efficacy in hemodialysis is considered similar to 
      unfractionated heparin (UFH), their safety remains controversial mainly due to a 
      risk of bioaccumulation in patients with renal impairment. The aim of this 
      systematic review was to evaluate the safety of LMWH when compared to UFH for 
      extracorporeal circuit (ECC) anticoagulation. METHODS: We used Pubmed, Embase, 
      Cochrane central register of controlled trials, Trip database and NICE to 
      retrieve relevant studies with no language restriction. We looked for controlled 
      experimental trials comparing LMWH to UFH for ECC anticoagulation among end-stage 
      renal disease patients undergoing chronic hemodialysis. Studies were kept if they 
      reported at least one of the following outcomes: bleeding, lipid profile, 
      cardiovascular events, osteoporosis or heparin-induced thrombocytopenia. Two 
      independent reviewers conducted studies selection, quality assessment and data 
      extraction with discrepancies solved by a third reviewer. Relative risk and 95% 
      CI was calculated for dichotomous outcomes and mean weighted difference (MWD) 
      with 95% CI was used to pool continuous variables. RESULTS: Seventeen studies 
      were selected as part of the systematic. The relative risk for total bleeding was 
      0.76 (95% CI 0.26-2.22). The WMD calculated for total cholesterol was 
      -28.70 mg/dl (95% CI -51.43 to -5.98), a WMD for triglycerides of -55.57 mg/dl 
      (95% CI -94.49 to -16.66) was estimated, and finally LDL-cholesterol had a WMD of 
      -14.88 mg/dl (95% CI -36.27 to 6.51). CONCLUSIONS: LMWH showed to be at least as 
      safe as UFH for ECC anticoagulation in chronic hemodialysis. The limited number 
      of studies reporting on osteoporosis and HIT does not allow any conclusion for 
      these outcomes. Larger studies are needed to evaluate properly the safety of LMWH 
      in chronic hemodialysis.
FAU - Lazrak, Hind Harrak
AU  - Lazrak HH
AD  - Maisonneuve-Rosemont Hospital Research Center, Montreal, Canada.
FAU - Rene, Emilie
AU  - Rene E
AD  - Maisonneuve-Rosemont Hospital Research Center, Montreal, Canada.
FAU - Elftouh, Naoual
AU  - Elftouh N
AD  - Maisonneuve-Rosemont Hospital Research Center, Montreal, Canada.
FAU - Leblanc, Martine
AU  - Leblanc M
AD  - Department of Medicine, University of Montreal, Montreal, Canada.
AD  - Division of Nephrology, Maisonneuve-Rosemont Hospital, 5415, boul. de 
      l'Assomption, Montreal, QC, H1T 2M4, Canada.
FAU - Lafrance, Jean-Philippe
AU  - Lafrance JP
AUID- ORCID: 0000-0001-7876-0446
AD  - Maisonneuve-Rosemont Hospital Research Center, Montreal, Canada. 
      jean-philippe.lafrance@umontreal.ca.
AD  - Department of Medicine, University of Montreal, Montreal, Canada. 
      jean-philippe.lafrance@umontreal.ca.
AD  - Division of Nephrology, Maisonneuve-Rosemont Hospital, 5415, boul. de 
      l'Assomption, Montreal, QC, H1T 2M4, Canada. jean-philippe.lafrance@umontreal.ca.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20170607
PL  - England
TA  - BMC Nephrol
JT  - BMC nephrology
JID - 100967793
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Clinical Trials as Topic/methods
MH  - Hemorrhage/chemically induced/epidemiology
MH  - Heparin, Low-Molecular-Weight/adverse effects/*therapeutic use
MH  - Humans
MH  - Kidney Failure, Chronic/epidemiology/*therapy
MH  - Osteoporosis/chemically induced/epidemiology
MH  - Pulmonary Embolism/chemically induced/epidemiology
MH  - Renal Dialysis/*trends
PMC - PMC5463373
OTO - NOTNLM
OT  - Bleeding
OT  - Chronic renal dialysis
OT  - Low molecular weight heparin
OT  - Meta-analysis
OT  - Systematic review
OT  - Unfractionated heparin
EDAT- 2017/06/09 06:00
MHDA- 2018/03/21 06:00
PMCR- 2017/06/07
CRDT- 2017/06/09 06:00
PHST- 2016/12/29 00:00 [received]
PHST- 2017/05/18 00:00 [accepted]
PHST- 2017/06/09 06:00 [entrez]
PHST- 2017/06/09 06:00 [pubmed]
PHST- 2018/03/21 06:00 [medline]
PHST- 2017/06/07 00:00 [pmc-release]
AID - 10.1186/s12882-017-0596-4 [pii]
AID - 596 [pii]
AID - 10.1186/s12882-017-0596-4 [doi]
PST - epublish
SO  - BMC Nephrol. 2017 Jun 7;18(1):187. doi: 10.1186/s12882-017-0596-4.