title: Efficacy and safety of low molecular weight heparin compared to unfractionated heparin for chronic outpatient hemodialysis in end stage renal disease: systematic review and meta-analysis.
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.
authors.affiliation: The Wright Center for Graduate Medical Education , Scranton, PA , USA ; The Johns Hopkins University, Bloomberg School of Public Health , Baltimore, MD , USA.
authors.forename: Ghanshyam
authors.initials: G
authors.lastname: Palamaner Subash Shantha
authors.affiliation: The Wright Center for Graduate Medical Education , Scranton, PA , USA ; The Johns Hopkins University, Bloomberg School of Public Health , Baltimore, MD , USA.
authors.forename: Anita Ashok
authors.initials: AA
authors.lastname: Kumar
authors.affiliation: Temple University School of Medicine , Philadelphia, PA , USA.
authors.forename: Mansha
authors.initials: M
authors.lastname: Sethi
authors.affiliation: Allen Foster Research Centre for Community Eye Health, International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute , Hyderabad , India.
authors.forename: Rohit C
authors.initials: RC
authors.lastname: Khanna
authors.affiliation: Department of Medicine, The Commonwealth Medical College , Scranton, PA , USA.
authors.forename: Samir Bipin
authors.initials: SB
authors.lastname: Pancholy
keywords: Hemodialysis; Heparin; Meta-analysis; Thromboprophylaxis