Use of Low Molecular Weight Heparin (Tinzaparin) to Treat Blood Clots in Patients With Kidney Failure

Launched by ST. JOSEPH'S HEALTHCARE HAMILTON · Sep 13, 2005

Keywords

ClinConnect Summary

Background and rationale. Venous thromboembolism (VTE) is an important clinical problem because it is common, preventable, contributes to morbidity and mortality, and is costly. Low molecular weight heparin (LMWH) is the preferred anticoagulant for VTE treatment, but is renally excreted. Consequently, LMWH use in patients with renal insufficiency may result in accumulation of the anticoagulant effects and the potential for avoidable bleeding complications. As a result, most patients with renal insufficiency who also have VTE are unable to benefit from LMWH treatment. These patients are ther...

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Eligibility criteria

• Inclusion Criteria:
• • Adult patients 18 years of age or older
• • Objectively confirmed VTE requiring anticoagulant therapy, including lower extremity and upper extremity deep vein thrombosis (catheter and non-catheter related, including dialysis access thrombosis \[i.e., graft, fistula\]); peripheral vein thrombosis (e.g., portal vein, mesenteric vein, cerebral vein thrombosis), and pulmonary embolism
• Exclusion Criteria:
• • Weight exceeding 105 kg
• • Unstable declining renal function, defined as documented change in creatinine \> 20% in the past 3 months or clinical circumstances likely to be associated with change in renal function, such as dehydration or severe intercurrent illness. Where no previous creatinine values exist and the patient is otherwise stable, patients will not be excluded on the basis of unknown previous renal function.
• • Known allergy to heparin/LMWHs or history of heparin induced thrombocytopenia
• • Treatment with UFH, LMWH, danaparoid, oral direct thrombin inhibitors for \>48 h
• • Bleeding requiring hospitalization or blood transfusion within 6 months(exception is blood transfusion given in relation to surgical procedures within 6 months)
• • History of intracerebral hemorrhage
• • Known active liver disease (AST or ALT \> 3 times the upper limit of normal, or bilirubin \> 50 umol/L)
• • Known active peptic ulcer disease, with ongoing symptoms or need for anti-ulcer medical therapy
• • Thrombocytopenia (platelet count of \< 100 x 109/L)
• • Ongoing need for antiplatelet agents (clopidogrel, ticlopidine, aspirin \> 325 mg daily)
• • Pregnancy or lactation
• • Geographic inaccessibility
• • Unable, or unwilling, to provide written informed consent