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Low-molecular-weight heparins should be used with caution in patients with chronic kidney disease

Nature Clinical Practice Nephrology volume 4, pages 488–489 (2008)Cite this article

In the general population, low-molecular-weight heparins (LMWHs) have largely replaced unfractionated heparin (UFH) for the treatment of deep vein thrombosis and pulmonary embolism, because of their superior efficacy and safety profile. In addition, most patients with uncomplicated deep vein thrombosis can be safely and effectively treated with LMWHs at home, thereby avoiding hospital admission.1 The trend towards more-frequent use of LMWHs could increase further following recent reports of the contamination of UFH with oversulfated chondroitin sulfate during the purification process, which resulted in hundreds of allergic reactions and at least four deaths.2

LMWHs seem to be as effective as UFH for the prevention of extracorporeal circuit thrombosis in patients on hemodialysis and are also equally safe in terms of the risk of bleeding complications.3 In our view, the approval of LMWHs for prevention of extracorporeal circuit thrombosis in patients on hemodialysis could be misleading, as physicians might assume that LMWH use is safe in patients with chronic kidney disease (CKD) who have other indications such as deep vein thrombosis, which requires high LMWH doses. Many reports and review articles in the literature clearly state, however, that LMWHs can cause severe adverse effects in such patients.4,5 Moreover, even patients receiving LMWH as an anticoagulant during dialysis are at risk of bleeding up to 10 h after a single bolus injection.6

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Authors and Affiliations

  1. M Gallieni is a Researcher, M Cozzolino is a Staff Nephrologist, C Ronga is a Nephrology Fellow and D Brancaccio is an Associate Professor in the Nephrology and Dialysis Unit, San Paolo Hospital, University of Milan, Milan, Italy.,

    Maurizio Gallieni, Mario Cozzolino, Chiara Ronga & Diego Brancaccio

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  1. Maurizio Gallieni
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  2. Mario Cozzolino
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  4. Diego Brancaccio
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Correspondence to Maurizio Gallieni.

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Gallieni, M., Cozzolino, M., Ronga, C. et al. Low-molecular-weight heparins should be used with caution in patients with chronic kidney disease. Nat Rev Nephrol 4, 488–489 (2008). https://doi.org/10.1038/ncpneph0879

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