Publication: Complicaciones hemorrágicas durante la utilzación de heparinas de bajo peso molecular en pacientes con insuficiencia renal
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2017-06-29
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Universidad Complutense de Madrid
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Abstract
Las heparinas de bajo peso molecular, son medicamentos anticoagulantes ampliamente empleados en los pacientes ingresados en los hospitales, tanto para el tratamiento de la enfermedad tromboembólica, como para su profilaxis. Se trata de medicamentos que llevan muchos años comercializados pero que, en determinadas poblaciones, como en el caso de los pacientes con función renal deteriorada, no están estudiados en profundidad. En estos pacientes se podría producir bioacumulación que podría acabar derivando en hemorragias, debido a la eliminación fundamentalmente renal de estos medicamentos. Varias agencias sanitarias de diferentes servicios de salud (Francia, Reino Unido) han emitido comunicados alertando del riesgo de su empleo a dosis plenas en este tipo de pacientes. Por otro lado, el Instituto para uso Seguro de los Medicamentos (ISMP), clasifica las HBPM como medicamentos de alto riesgo, identificando a los pacientes con insuficiencia renal como pacientes más vulnerables. No se dispone de los mismos datos para las diferentes heparinas de bajo peso molecular en pacientes con insuficiencia renal. La más estudiada ha sido enoxaparina, para la que existen recomendaciones claras de monitorización (mediante la medición del anti-Xa) y ajuste de dosis, tanto en profilaxis como en tratamiento, en pacientes con aclaramiento de creatinina por debajo de 30 mL/min. En el presente trabajo se han estudiado dos HBPM (dalteparina y bemiparina) en las que no hay datos concluyentes sobre el riesgo de hemorragia en esta subpoblación de pacientes...
Low molecular weight heparins (LMWH) are widely used anticoagulants in inpatients to prevent or treat thromboembolic disease. Despite these drugs have been commercialized for a very long time, there are some special situations, such as renal disease patients, in which their use has not been deeply studied. An accumulation of these drugs could happen in these patients leading to hemorrhage, due to the renal elimination of these molecules. The reduction in the elimination could cause hemorrhages. Several sanitary agencies (France, England), have published reports warning about the use of LMWH in these patients without dose adjustments. The Institute for Safe Medication Practice, classifies these molecules as high risk drugs, especially in those patients with renal impairment (RI). The current knowledge about the effects of different LMWHs on patients suffering from RI is diverse. The best known LMWH is enoxaparin. Some recommendations about monitoring and adjusting the dose of enoxaparin for treatment and prophylaxis in patients with clearance of serum creatinine < 30 mL/min have been widely established. In this work two LMWHs (dalteparin and bemiparin) for which there are no conclusive data of management in RI patients, are studied...
Low molecular weight heparins (LMWH) are widely used anticoagulants in inpatients to prevent or treat thromboembolic disease. Despite these drugs have been commercialized for a very long time, there are some special situations, such as renal disease patients, in which their use has not been deeply studied. An accumulation of these drugs could happen in these patients leading to hemorrhage, due to the renal elimination of these molecules. The reduction in the elimination could cause hemorrhages. Several sanitary agencies (France, England), have published reports warning about the use of LMWH in these patients without dose adjustments. The Institute for Safe Medication Practice, classifies these molecules as high risk drugs, especially in those patients with renal impairment (RI). The current knowledge about the effects of different LMWHs on patients suffering from RI is diverse. The best known LMWH is enoxaparin. Some recommendations about monitoring and adjusting the dose of enoxaparin for treatment and prophylaxis in patients with clearance of serum creatinine < 30 mL/min have been widely established. In this work two LMWHs (dalteparin and bemiparin) for which there are no conclusive data of management in RI patients, are studied...