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See Latest ArticlesStudy of bioaccumulation of dalteparin at a therapeutic dose in patients with renal insufficiency
Journal of Thrombosis and Haemostasis, 09/25/09
Wuillemin WA et al. – Therapeutically dosed dalteparin accumulates in patients with severe RI (group C). Dose adjustments according to anti–Xa are recommended for dalteparin if used in this patient population. However, no simple dosing scheme can be suggested yet because of wide inter–individual variation.
Pirmin Schmid and Walter A. Wuillemin, 09/30/09
| Low-molecular-weight heparins (LMWH) are effective, safe and convenient for anticoagulation. Their use is limited in patients with renal insufficiency (RI) because of bioaccumulation. Patients with severe RI (i.e. glomerular filtration rate GFR < 30 mL/min/1.73 m^2) have both, an increased bleeding risk and an increased risk for thromboembolic events. The pharmacokinetic data of a specific LMWH cannot be transferred to other LMWH because of various levels of bioaccumulation in RI (Swiss Med Wkly 2009;139:438-52). The present study reports bioaccumulation data of therapeutically dosed dalteparin in patients with severe RI. It extends the previously reported results of prophylactically dosed dalteparin in patients with severe RI that showed no significant bioaccumulation up to median 10 days of prophylaxis (J Thromb Haemost 2009;7:552-8). Controls of anti-Xa levels and dose adjustments according to these values are recommended for therapeutically dosed dalteparin if used in this patient population. However, no simple dosing scheme can be suggested yet because of wide inter-individual variation. Furthermore, i.v. unfractionated heparin (UFH) may be preferred to s.c. LMWH for sub-populations with certain risk factors as detailed in the article. A larger study is recommended that would be powered also for clinical end-points. |
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