Enoxaparin vs. unfractionated heparin for anticoagulation during continuous veno-venous hemofiltration: a randomized controlled crossover study

Abstract

Enoxaparin can be safely used for anticoagulation during CVVH resulting in higher filter lifespan compared with unfractionated heparin.

Enoxaparin versus unfractioned heparin as anticoagulant for continuous venovenous hemodialysis: a randomized open-label trial

“…No major bleeding occurred, but 26% of the patients in the enoxaparin group had minor bleeding episodes. This finding differs from the report by Reeves et al 30 and by Joannidis et al 35 who found no difference in the prevalence of hemorrhagic complications between the two methods of anticoagulation.…”

“…Reeves et al 30 compared dalteparin with UFH in patients submitted to continuous venovenous hemodiafiltration, reporting a filter life span of 46.8 versus 51.7 hours for dalteparin and UFH, respectively, which is very similar to what was found in this study. In another study, 35 enoxaparin was associated with a longer filter life span as compared to UFH (30.6 ± 25.3 vs. 21.7 ± 16.9 hours, p = 0.017).…”

“…8 In this latter study, neither thrombocytopenia nor bleeding was reported in association with enoxaparin. Joannidis et al 35 in a controlled randomized crossover trial studying 37 patients in continuous venovenous hemofiltration, reported that enoxaparin as compared to UFH resulted in a significantly longer filter survival without increasing bleeding complications, but in this study enoxaparin dose was adjusted according to antiXa levels targeted at 0.25-0.30 IU/mL.…”

“…40 In this context, it is important to emphasize the need to adjust LMWH dose in patients on CRRT based on anti-Xa activity, because with target levels of anti-Xa the incidence of bleeding complications decreases as reported by several authors. 11,15,[28][29][30][33][34][35]39 This was addressed by Lim et al in a recent meta-analysis 29 , showing that major bleeding was increased when standard doses of enoxaparin were used but did not increase with empirically adjusted doses. Even though enoxaparin dose was reduced on account of severe renal insufficiency, we recognize as a limitation of our study the use of enoxaparin in fixed doses of 40 mg not adjusted for patient weight, without monitoring and targeting the level of anti-factor Xa perhaps at less than 0.9 IU/mL.…”

“…24,35 Perhaps a more steady plasmatic level of the drug could affect less the activity of factor Xa and the coagulation cascade, resulting in a lower rate of bleeding.…”