Use of Low Molecular Weight Heparins in Patients with Renal Failure; Time to Re-evaluate Our Preconceptions

Excerpt

Low molecular weight heparins (LMWHs) have largely replaced unfractionated heparin (UFH) in many clinical settings as a result of their predictable pharmacokinetics, eliminating the need for routine laboratory monitoring, convenient subcutaneous administration and non-inferior efficacy compared to UFH. Fixed or weight-based dosing and widespread use of pre-filled syringes provide a safety advantage over UFH through a reduction in the likelihood of medication error. For many indications, therapeutic efficacy is achieved with LMWH at a lower bleeding risk compared to UFH. However, facility-wide utilization of LMWH for all prophylactic and therapeutic indications has been impeded by a perception that patients with renal insufficiency cannot receive LWMH due to a risk of bioaccumulation leading to bleeding. Given the prevalence of acute and chronic kidney disease, renal impairment is a real concern for practicing clinicians considering the use of LWMH. In many facilities, UFH remains the default option for anticoagulating patients with renal impairment, despite the complexity of its use and its known toxicity profile. …