Increased major bleeding risk in patients with kidney dysfunction receiving enoxaparin: a meta-analysis

Hoffmann, P; Keller, Frieder

doi:10.1007/s00228-011-1149-6

Cited by 50 publications

(36 citation statements)

References 31 publications

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“…One small rct comparing tinzaparin and dalteparin found that both drugs accumulated in hemodialysis patients at therapeutic doses 41 . Similarly, a meta-analysis found an increase in bleeding risk with enoxaparin in patients with renal impairment 40 . Compared with longer-course treatment, short-course therapeutic doses (up to 5 days) of dalteparin or tinzaparin are less likely to be associated with bioaccumulation and might be reasonable for initiating oral anticoagulation with warfarin therapy.…”

Section: Moderate-to-severe Renal Impairmentmentioning

confidence: 94%

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Clinical Challenges in Patients with Cancer-Associated Thrombosis: Canadian Expert Consensus Recommendations

et al. 2015

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general population is increased by a factor of 4 1 . In the cancer patient population, thromboembolism is associated with significant morbidity and mortality, and it is the second most common cause of death after cancer progression 2 . A number of published clinical practice guidelines have provided recommendations to medical oncologists for the management of cancer-associated thrombosis 3-5 ; however, currently available guidelines do not provide recommendations for challenging clinical situations (for example, thrombocytopenia, recurrent vte, catheter-related upper extremity dvt, etc.) encountered by health care practitioners caring for this patient population. METHODSThe purpose of the consensus process was to develop specific recommendations and to provide expert guidance for challenging cases that are not currently addressed in clinical practice guidelines on the treatment and prevention of vte in patients with cancer. The specific questions to be addressed were identified by the participants and supplemented by a systematic review of the available literature. Sources and SearchesFor each of the identified challenges, the literature in medline (1946 to March 2014), embase (1947 to March 2014), the Cochrane Central Register of Controlled Trials, and all Evidence Based Medicine Reviews (using the ovid interface) was systematically reviewed. References in included studies and previous systematic reviews were also reviewed for additional potential studies. The search was limited to human studies reported in the English language. One of the medline search strategies is depicted in Table i. Grading of the Evidence and Consensus ProcessThe multidisciplinary expert consensus group, which included 21 voting participants with expertise ABSTRACTVenous thromboembolism is a common complication in cancer patients, and thromboembolism is the second most common cause of death after cancer progression. A number of clinical practice guidelines provide recommendations for the management of cancerassociated thrombosis. However, the guidelines lack recommendations covering commonly encountered clinical challenges (for example, thrombocytopenia, recurrent venous thromboembolism, etc.) for which little or no evidence exists. Accordingly, recommendations were developed to provide expert guidance to medical oncologists and other health care professionals caring for patients with cancer-associated thrombosis. The current expert consensus was developed by a team of 21 clinical experts. For each identified clinical challenge, the literature in medline, embase, and Evidence Based Medicine Reviews was systematically reviewed. The quality of the evidence was assessed, summarized, and graded. Consensus statements were generated, and the experts voted anonymously using a modified Delphi process on their level of agreement with the various statements. Statements were progressively revised through separate voting iterations and were then finalized. Clinicians using these recommendations and suggestions should tailor patient management accord...

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Section: Moderate-to-severe Renal Impairmentmentioning

confidence: 94%

“…One large rct 36 and two smaller cohort studies 37,38 concluded that dalteparin at prophylactic doses was unlikely to contribute to bleeding in patients with renal impairment. Enoxaparin at prophylactic doses might bioaccumulate in patients with severe renal dysfunction, and dose reduction is recommended 39,40 .…”

Section: Moderate-to-severe Renal Impairmentmentioning

confidence: 99%

Clinical Challenges in Patients with Cancer-Associated Thrombosis: Canadian Expert Consensus Recommendations

et al. 2015

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“…The included trials compared enoxaparin (typically 1 mg/kg every 12 hours) with ufh, fondaparinux, or tinzaparin, and treatment was given for a total of 1.5-10 days. The data revealed a significant increase in major bleeding with enoxaparin compared with the other anticoagulants (relative risk: 1.67; 95% ci: 1.12 to 2.50; p = 0.01); notably, however, the criteria used to measure major bleeding complications varied widely 31 . None of the available data are cancer-specific.…”

Section: Patients With Renal Insufficiencymentioning

confidence: 97%

“…The review concluded that warfarin should not be used in patients with advancing progressive disease 28 . The prothrombotic tendency of patients with advanced cancer suggests a need for indefinite treatment [28][29][30][31] . Currently, randomized clinical data support the use of lmwh treatment for 3-6 months 11,12 is often given for 6 months.…”

Section: Advanced Cancer and Duration Of Therapymentioning

confidence: 99%

Canadian consensus recommendations on the management of venous thromboembolism in patients with cancer. Part 2: treatment

Easaw¹,

Shea‐Budgell²,

Wu³

et al. 2015

Curr. Oncol.

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Patients with cancer are at increased risk of venous thromboembolism (vte). Anticoagulation therapy is used to treat vte; however, patients with cancer have unique clinical circumstances that can often make decisions surrounding the administration of therapeutic anticoagulation complicated. No national Canadian guidelines on the management of established cancer-associated thrombosis have been published. We therefore aimed to develop a consensus-based, evidence-informed guideline on the topic.PubMed was searched for clinical trials and meta-analyses published between 2002 and 2013. Reference lists of key articles were hand-searched for additional publications. Content experts from across Canada were assembled to review the evidence and make recommendations.Low molecular weight heparin is the treatment of choice for cancer patients with established vte. Direct oral anticoagulants are not recommended for the treatment of vte at this time. Specific clinical scenarios, including the presence of an indwelling venous catheter, renal insufficiency, and thrombocytopenia, warrant modifications in the therapeutic administration of anticoagulation therapy. Patients with recurrent vte should receive extended (>3 months) anticoagulant therapy. Incidental vte should generally be treated in the same manner as symptomatic vte. There is no evidence to support the monitoring of anti–factor Xa levels in clinically stable cancer patients receiving prophylactic anticoagulation; however, levels of anti–factor Xa could be checked at baseline and periodically thereafter in patients with renal insufficiency. Follow-up and education about the signs and symptoms of vte are important components of ongoing patient care.

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“…In addition, it is indicated that ICH risk will rise with the increasing of drug dosage, age and degree of kidney damage. And a meta-analysis research found that when the low molecular heparin was used in patients with glomerular filtration rate <60 mL/minalthough the dose has been adjusted, the relative risk of bleeding is still as high as 1.67 [18].…”

Section: Parenteral Anticoagulants Related Cerebral Hemorrhage Commonmentioning

confidence: 99%

The Influence of Antithrombotic Drug Application on Intracranial Hemorrhage

Xu¹

2017

J Trauma Treat

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Thrombosis is caused by many diseases or complications, such as cerebrovascular disease, coronary heart disease, pulmonary thromboembolism, deep vein thrombosis after surgery and trauma, thus effective antithrombotic therapy has very important significance to the health of human beings. However, more and more clinical reports showed hemorrhage issues induced by antithrombotic treatment, especially in the central nervous system. Accordingly, in this paper, the relationship between common oral anticoagulants applied in clinic and the related problems about intracerebral hemorrhage will be reviewed.

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Increased major bleeding risk in patients with kidney dysfunction receiving enoxaparin: a meta-analysis

Abstract: Only patients with a GFR > 60 ml/min can be safely treated with enoxaparin.

Cited by 50 publications

References 31 publications

Clinical Challenges in Patients with Cancer-Associated Thrombosis: Canadian Expert Consensus Recommendations

Clinical Challenges in Patients with Cancer-Associated Thrombosis: Canadian Expert Consensus Recommendations

Canadian consensus recommendations on the management of venous thromboembolism in patients with cancer. Part 2: treatment

The Influence of Antithrombotic Drug Application on Intracranial Hemorrhage

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