Niedermolekulare Heparine bei Niereninsuffizienz

Zusammenfassung

Niedermolekulare Heparine (NMH) weisen Vorteile in der therapeutischen Effektivität und der Sicherheit der Anwendung gegenüber dem herkömmlichen unfraktionierten Heparin (UFH) auf. Wegen der vorwiegend renalen Elimination können bei Niereninsuffizienz Komplikationen unter NMH auftreten. Die Kenntnisse über die Anwendung dieser Substanzen bei Niereninsuffizienz beruhen auf Einzeldosisstudien, retrospektiven Analysen und prospektiven, nicht randomisierten Studien. In den großen randomisierten Studien zur Anwendung der NMH (z. B. beim akuten Koronarsyndrom) war die Niereninsuffizienz in der Regel ein Ausschlusskriterium.

Aufgrund der vorliegenden Befunde ist die NMH-Anwendung bei schwerer Niereninsuffizienz nur unter besonderen Voraussetzungen üblich. Bei mittelgradiger und schwerer Niereninsuffizienz kann ein Monitoring mittels Kontrolle der Anti-Xa-Aktivität erfolgen. Ein Grenzbereich der Nierenfunktionseinschränkung, ab der mit erhöhter Blutungsrate zu rechnen ist, ist nicht definiert.

Summary

Low molecular weight heparin offers several advantages concerning therapeutic efficacy and safety as compared to unfractionated heparin. Due to renal clearance of low molecular weight heparin problems with the use of low molecular weight heparins may occur in patients with renal failure. Current experience using low molecular weight heparin in patients with renal failure is based on single-dose pharmacokinetic studies, on retrospective analysis and on non-randomized prospective studies. Large randomized studies investigating the use of low molecular weight heparin (e. g. in acute coronary syndrome) have excluded patients with renal failure.

Based on the findings mentioned above, treatment with low molecular weight heparin in patients with severe renal failure should follow only under special conditions. In moderate to severe renal failure monitoring anti-Xa activity may be useful to avoid bleeding complications. A definite cut-off level for a potential increase of bleeding complications with the use of low molecular weight heparins in renal failure has not been defined.

Schlüsselwörter

Niedermolekulare Heparine - Niereninsuffizienz - Blutungskomplikationen - Antikoagulation

Keywords

Low molecular weight heparin - renal failure - bleeding complications - anticoagulation

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