Niedermolekulare Heparine bei Niereninsuffizienz – Was ist bei der Anwendung zu beachten?

Niedermolekulare Heparine (LMWH: Low-Molecular Weight Heparin) unterscheiden sich von unfraktioniertem Heparin (UFH) in Wirkung und Pharmakokinetik. Je niedriger das Molekulargewicht eines Heparins ist, desto stärker hängt dessen Elimination von der Nierenfunktion ab. Deshalb sind bei einer Anwendung von LMWH bei Patienten mit höhergradiger Niereninsuffizienz eine Dosisanpassung und eine Kontrolle der Anti-Xa-Aktivität im Plasma zu erwägen. Einige LMWH sind, abhängig von der Indikation, bei einer Kreatinin-Clearance von unter 30 ml/min nicht zugelassen. Neben einem erhöhten Blutungsrisiko sollte auch an andere unerwünschte Arzneimittelwirkungen, wie die Hyperkaliämie, gedacht werden.

Low-molecular weight heparins (LMWH) differ from unfractionated heparin (UFH) in view to drug effects and pharmacokinetics. The elimination of low-molecular weight heparin fragments depends on kidney function. Thus, drug dose adjustment and quantification of anti-Xa activity in plasma must be considered in patients with renal impairment treated with LMWH. Some LMWH are not approved for patients with a creatinine clearance of less than 30 ml/min, depending on the indication. Adverse reactions include increased bleeding risk, but also hyperkalaemia.

Key words

unfractionated heparin - low-molecular weight heparin (LMWH) - renal impairment - haemodialysis

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