Low-molecular-weight heparins for the treatment of acute coronary syndrome and venous thromboembolism in patients with chronic renal insufficiency.
The clinical management of patients with renal insufficiency who develop an acute coronary syndrome or venous thromboembolism is a common clinical scenario that is problematic because of the lack of well-designed randomized trials assessing management strategies in such patients. Impaired renal function is common in patients who develop thromboembolic disorders, particularly in elderly patients in whom renal insufficiency is under-recognized. Low-molecular-weight heparins (LMWHs), which are the most widely used anticoagulant for the treatment of patients with an acute coronary syndrome or venous thromboembolism, are eliminated primarily by the kidney and, therefore, pose treatment challenges in patients with impaired renal function. However, there is emerging evidence regarding the use of LMWHs in patients with impaired renal function suggesting that some preparations may be safe in such patients. The objective of this review is to discuss the clinical management of patients with renal insufficiency who develop an acute coronary syndrome or venous thromboembolism, and to explore similarities and differences of LMWHs when used in this clinical setting.
Lim
Wendy
W
Department of Medicine, McMaster University and St. Joseph's Hospital, 50 Charlton Avenue East, Hamilton, Ontario, Canada L8N 4A6.
Al Saleh
Khalid
K
Douketis
James D
JD
D000208:Acute Disease; D000789:Angina, Unstable / Q000188:drug therapy* / Q000209:etiology*; D000925:Anticoagulants / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000534:rehabilitation; D009203:Myocardial Infarction / Q000188:drug therapy / Q000209:etiology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D006435:Renal Dialysis; D013577:Syndrome; D020246:Venous Thrombosis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight