AI Article Synopsis
- Low-molecular-weight heparins (LMWHs) are commonly used to prevent and treat venous thromboembolism (VTE), but their use in patients with chronic kidney disease (CKD) poses a bleeding risk, especially when creatinine clearance is below 30 mL/min.
- The structure of LMWHs varies, and tinzaparin, having a larger molecular weight, is less reliant on kidney function for elimination, which could make it safer for CKD patients.
- Clinical studies have indicated that using therapeutic doses of tinzaparin in cancer patients with CKD does not lead to accumulation of anticoagulant activity or increased bleeding risk, eliminating the need for monitoring or dose adjustments.
Article Abstract
Low-molecular-weight heparins (LMWHs) are the mainstay of the prophylaxis and treatment of venous thromboembolism (VTE). Due to their renal elimination, the risk of accumulation with the related bleeding risk may represent a limitation for the use of LMWHs in patients with chronic kidney disease (CKD) as the risk of major bleeding is increased in patients with creatinine clearance (CrCl) < 30 mL/min, especially in patients with cancer. LMWH structure and molecular weight (MW) are heterogeneous among available agents. The elimination of tinzaparin, which has the highest mean MW among LMWHs, is less dependent on renal function as it is also metabolized through the reticuloendothelial system. A subcutaneous therapeutic dose of tinzaparin (175 IU/kg) once daily has been shown to cause no accumulation of anti-factor Xa activity in patients with CrCl ≥ 20 mL/min. Clinical experience from randomized controlled studies has shown no significant impact of CKD on bleeding risk in cancer patients receiving treatment doses of tinzaparin. This suggests that in these patients the use of treatment doses of tinzaparin does not require anticoagulation monitoring or dose adjustment.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266849 | PMC |
| http://dx.doi.org/10.1007/s40256-019-00382-0 | DOI Listing |
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