, Volume 3, Issue 4, pp 307-309
Date: 20 Sep 2008

How to handle low-molecular-weight heparins in patients with decreased renal function: an open issue

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Chronic renal failure is a leading cause of morbidity and mortality in Western countries [1]. The prevalence of patients with end stage renal disease (ESRD) is growing constantly, and ever more frequently require physicians of several specialties to manage these patients with reduced renal function. An example of this event is the prevention and treatment of venous thromboembolism (VTE), acute deep vein thrombosis (DVT) or pulmonary embolism (PE) with heparins. Heparins are the most effective treatment for the thromboembolic disorders, but their management requires careful usage in patients with reduced glomerular filtration rate (GFR).

Heparin is an indirect thrombin inhibitor that forms complexes with antithrombin (AT, formerly known as AT III), and converts this circulating cofactor from a slow to a rapid inactivator of thrombin, factor Xa, and to a lesser extent, factors XIIa, XIa, and IXa [2, 3]. The binding of heparin to the heparin binding site on AT produces a conformational cha ...