Welche niedermolekularen Heparine bei Niereninsuffizienz?

Abstract

Background: In most clinical settings, low-molecular-weight heparins (LMWH) are preferred over unfractionated heparin (UHF). However, the use of LMHW in patients with renal insufficiency is limited because they tend to accumulate. Methods: The literature is reviewed regarding pharmacologic properties of different LMWHs and their use in patients with renal insufficiency. Results: The risk of accumulation is dependent on the molecular weight: smaller LMHW have a higher risk of accumulation. Therefore, a LMHW with high molecular weight should be chosen. The patient's individual renal function, bleeding risk and the chance of upcoming interventions need to be assessed. When LMWH are used in patients with renal insufficiency, peak Anti-Xa levels must be monitored closely. Conclusions: LMWH can be used in patients with severe renal insufficiency if a close monitoring of the patient and the therapeutic effect is possible.

Literatur

• 1 Schmid P, Fischer A G, Wuillemin W A. Low-molecular-weight heparins in patients with renal insufficiency.  Swiss Med Wkly. 2009;  139 438-452
• 2 Hirsh J, Bauer K A, Donati M B et al. Parenteral Anticoagulants: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).  Chest. 2008;  133 141-159
• 3 Samama M M et al. A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. Prophylaxis in Medical Patients with Enoxaparin Study Group.  N Engl J Med. 1999;  341(11) 793-800
• 4 Mahe I, Aghassarian M, Drouet L et al. Tinzaparin and enoxaparin given at prophylactic dose for eight days in medical elderly patients with impaired renal function: a comparative pharmacokinetic study.  Thromb Haemost. 2007;  97(4) 581-586
• 5 Gounin-Thibault I, Pautas E, Siguret V. Safety profile of different low-molecular weight heparins used at therapeutic dose.  Drug Safety. 2005;  28,4 333-349
• 6 Sagedal S, Hartmann A. Low molecular weight heparins as thromboprophylaxis in patients undergoing hemodialysis/hemofiltration or continous renal replacement therapies.  Eur J Med Res. 2004;  9 125-130
• 7 Siguret V, Pautas E, Fevrier M et al. Elderly patients treated with tinzaparin (Innohep) administered once daily (175 anti-Xa IU/kg): anti-Xa and anti-IIa activities over 10 days.  Thromb Haemost. 2000;  5 800-804
• 8 Pautas E, Siguret V, d'Urso M et al. Surveillance d’un traitement par la tinzaparine à dose curative pendant dix jours chez le sujet agé.  Rev Med Interne. 2001;  22 120-126
• 9 Pautas E, Gouin I, Bellot O et al. Safety profile of tinzaparin administered once daily at a standard curative dose in two hundred very elderly patients.  Drug Saf. 2002;  25 725-733
• 10 Leizorovicz A, Siguret V, Mottier D. Safety profile of tinzaparin versus subcutaneous unfractionated heparin in elderly patients with impaired renal function treated for acute deep vein thrombosis: The Innohep in Renal Insufficiency Study (IRIS).  Thromb Res. 2011;  128 27-34
• 11 Shprecher A R, Cheng-Lai A, Madsen E M et al. Peak antifactor Xa activity produced by dalteparin treatment in patients with renal impairment compared with controls.  Pharmacotherapy. 2005;  6 817-822
• 12 Bazinet A, Almanric K, Brunet C et al. Dosage of enoxaparin among obese and renal impairment patients.  Thromb Res. 2005;  116 41-50
• 13 Bauersachs R, Schellong S M, Haas S et al. CERTIFY: Prophylaxis of venous thromboembolism in patients with severe renal insufficiency.  Thromb Haemost. 2011;  105 981-986
• 14 Mismetti P, Laporte-Simitsidis S, Nevarro C et al. Aging and venous thromboembolism influence the pharmacodynamics of the anti-factor Xa and anti-thrombin activities of a low molecular weight heparin (nadroparin).  Thromb Haemost. 1998;  79 1162-1165