Low-Molecular-Weight Heparin and Bleeding: How Do We Lower Risk but Maintain Benefit?
Authors: T. S. Dharmarajan, Amit Sohagia
Journal: Annals of Internal Medicine (2006)

Letters21 November 2006Low-Molecular-Weight Heparin and Bleeding: How Do We Lower Risk but Maintain Benefit?T. S. Dharmarajan, MD and Amit Sohagia, MDT. S. Dharmarajan, MDFrom Our Lady of Mercy Medical Center, Bronx, New York.Search for more papers by this author and Amit Sohagia, MDFrom Our Lady of Mercy Medical Center, Bronx, New York.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-145-10-200611210-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR: We read with interest the important information in the recent meta-analysis by Lim and colleagues (1). The meta-analysis suggested that patients with severe renal insufficiency who are receiving standard doses of enoxaparin have an increased risk for major bleeding that may be attributable to an elevated level of anti-Xa. The presence of renal impairment causes a delay in the elimination of enoxaparin. In fact, a linear relationship between anti-Xa plasma clearance and steady-state creatinine clearance correlates with decline in enoxaparin clearance and resultant increased anticoagulant activity (2). While Lim and colleagues and others recommend a reduction in ...References1. Lim W, Dentali F, Eikelboom JW, Crowther MA. Meta-analysis: low-molecular-weight heparin and bleeding in patients with severe renal insufficiency. Ann Intern Med. 2006;144:673-84. [PMID: 16670137] LinkGoogle Scholar2. Chow SL, Zammit K, West K, Dannenhoffer M, Lopez-Candales A. Correlation of antifactor Xa concentrations with renal function in patients on enoxaparin. J Clin Pharmacol. 2003;43:586-90. [PMID: 12817521] CrossrefMedlineGoogle Scholar3. Hulot JS, Montalescot G, Lechat P, Collet JP, Ankri A, Urien S. Dosing strategy in patients with renal failure receiving enoxaparin for the treatment of non-ST-segment elevation acute coronary syndrome. Clin Pharmacol Ther. 2005;77:542-52. [PMID: 15961985] CrossrefMedlineGoogle Scholar4. Poggio ED, Hall PM. Estimation of glomerular filtration rate by creatinine-based formulas: any room for improvement [Editorial]. Nephrology Self-Assessment Program. 2006;5:131-40. Google Scholar5. Hulot JS, Vantelon C, Urien S, Bouzamondo A, Mahé I, Ankri A, et al. Effect of renal function on the pharmacokinetics of enoxaparin and consequences on dose adjustment. Ther Drug Monit. 2004;26:305-10. [PMID: 15167633] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Our Lady of Mercy Medical Center, Bronx, New York.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMeta-Analysis: Low-Molecular-Weight Heparin and Bleeding in Patients with Severe Renal Insufficiency Wendy Lim , Francesco Dentali , John W. Eikelboom , and Mark A. Crowther Metrics Cited byAnti-GRP78 autoantibodies induce endothelial cell activation and accelerate the development of atherosclerotic lesionsMedications, Renal Function, and Kidney Injury: A Complex Interplay, Wherein Prevention Is Easier Than Cure! 21 November 2006Volume 145, Issue 10Page: 789-790KeywordsAdipose tissueBody weightCreatinineHealth careHemorrhagePharmacokineticsProphylaxisRenal analysisRenal diseases ePublished: 21 November 2006 Issue Published: 21 November 2006 Copyright & PermissionsCopyright © 2006 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...