Abstract
Background. Low molecular weight heparin (LMWH) is an effective anti-coagulant for thrombotic events. However, due to its predominant renal clearance, there are concerns that it might be associated with increased bleeding in patients with renal disease.Objectives. We systematically evaluated the efficacy and safety of LMWH compared to unfractionated heparin (UH) in end stage renal disease (ESRD) patients.Search Methods. Pubmed, Embase and cochrane central were searched for eligible citations.Selection Criteria. Randomized controlled trials, comparing LMWH and UH, involving adult (age > 18 years), ESRD patients receiving outpatient, chronic, intermittent hemodialysis were included.Data Collection and Analysis. Two independent reviewers performed independent data abstraction. I2 statistic was used to assess heterogeneity. Random effects model was used for meta-analysis.Results. Nineteen studies were included for systematic review and 4 were included for meta-analysis. There were no significant differences between LMWH and UFH for extracorporeal circuit thrombosis [risk ratio: 1 (95% CI [0.62–1.62])] and bleeding complications [risk ratio: 1.16 (95% CI [0.62–2.15])].Conclusions. LMWH is as safe and effective as UFH. Considering the poor quality of studies included for the review, larger well conducted RCTs are required before conclusions can be drawn.
Highlights
Chronic kidney disease (CKD) was prevalent in 25.8 million adults in the United States in 2004 (Snyder, Foley & Collins, 2009)
The rationale for our systematic review and meta-analysis are: (1) we have focused our comparison to Low molecular weight heparin (LMWH) and unfractionated heparin (UH) only
Our review will be clinically useful since 95% centers around the globe use only these 2 drugs and not citrate as analyzed in the review by Lim, Cook & Crowther (2004), (2) we have focused our review to only those LMWH that are currently approved by the Food and Drug Administration (FDA)
Summary
Chronic kidney disease (CKD) was prevalent in 25.8 million adults in the United States in 2004 (Snyder, Foley & Collins, 2009). Used LMWH are Bemiparin, Certoparin, Dalteparin, Enoxaparin, Nadroparin, Parnaparin, Reviparin and Tinzaparin (Gould et al, 1999). They have a lower incidence of heparin induced thrombocytopenia (Gould et al, 1999; Gray, Mulloy & Barrowcliffe, 2008; Nicolaides, 2006) compared to UH (Gould et al, 1999). Considering the poor quality of studies included for the review, larger well conducted RCTs are required before conclusions can be drawn
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