December 9, 2002Archives of Internal Medicine
Is Impaired Renal Function a Contraindication to the Use of Low-Molecular-Weight Heparin?
Key result
A systematic review of 5 trials found that a 30-mL/min creatinine clearance cutoff is not justified to select individuals at increased risk of accumulation when low-molecular-weight heparin is used.
Why the study?
Does impaired renal function contraindicate the use of low-molecular-weight heparin in nondialyzed patients?
Population
Nondialyzed patients with varying degrees of renal function
Comparison
Low-molecular-weight heparin preparations vs Patients with different degrees of renal function
Design
Systematic_review
Authors
Discussion
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Member takes
Implication
May warrant caution with LMWH in severe renal impairment; leaves open need for RCTs on dosing and monitoring.
Key Points
- To evaluate whether impaired renal function is a contraindication for low-molecular-weight heparin use.
- Conducted a systematic search of MEDLINE, EMBASE, and International Pharmaceutical Abstracts.
- Identified prospective articles comparing pharmacokinetics of low-molecular-weight heparins in nondialyzed patients.
- Reviewed reference lists for additional studies.
- Three trials did not support a 30 mL/min creatinine clearance cutoff for LMW heparin usage.
- Four out of five trials indicated risk of accumulation of anti-factor Xa activity in patients with impaired renal function.
- Tinzaparin sodium did not show accumulation in patients with creatinine clearance as low as 20 mL/min.
Study Design
Type
Systematic Review
Structured PICO
Does impaired renal function contraindicate the use of low-molecular-weight heparin in nondialyzed patients?
P
Population
Systematic review of 5 trials assessing the pharmacokinetics of low-molecular-weight heparins in nondialyzed patients with varying degrees of renal function.
I
Intervention
Low-molecular-weight (LMW) heparin preparations (including tinzaparin sodium)
C
Comparator
Patients with different degrees of renal function
O
Outcome
Pharmacokinetics of LMW heparins (accumulation of anti-factor Xa activity)surrogate
A 30-mL/min creatinine clearance cutoff is not justified as a universal contraindication for LMW heparins, as pharmacokinetic responses vary among preparations, with tinzaparin showing no accumulation down to 20 mL/min.
Cite This Study
Nagge et al. (2002) conducted a systematic review in Impaired renal function. Low-molecular-weight heparin was evaluated on Pharmacokinetics and accumulation of anti-factor Xa activity. A systematic review of 5 trials found that a 30-mL/min creatinine clearance cutoff is not justified to select individuals at increased risk of accumulation when low-molecular-weight heparin is used.