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Heparin is the most commonly prescribed anticoagulant for continuous renal replacement therapy. There is, however, increasing evidence questioning its safety, particularly in the critically ill. Heparin mainly confers its anticoagulant effect by binding to antithrombin. Heparin binds to numerous other proteins and cells as well, however, compromising its efficacy and safety. Owing to ...
The indication for heparin should be reviewed daily. Heparin should be avoided in patients with an increased bleeding risk. 2. Unfractionated heparin is administered via the circuit unless the patient needs systemic anticoagulation for other reasons. 3. The dose of heparin is based on actual body weight. 4.
In most cases this will consist of either unfractionated heparin or low molecular weight heparin (LMWH). Unfraction-ated heparin at a dose of 5000 U subcutaneous twice or three times daily is the preferred anticoagulant in North America, while LMWH at prophylactic doses is used most frequently in Europe.
Spinler SA, Wittkowsky AK, Nutescu EA, Smythe MA. Anticoagulation monitoring part 2: unfractionated heparin and low-molecular-weight heparin. Ann Pharmacother. 2005;39(7–8):1275–85. CAS PubMed Google Scholar Ammar T, Fisher CF, Sarier K, Coller BS. The effects of thrombocytopenia on the activated coagulation time.
Regional citrate anticoagulation was compared with systemic low molecular weight heparin (LMWH) in two trials (n = 268 in total) . The larger trial (n = 215) using nadroparin reported similar filter life in the two groups (median, 27 h vs. 26 h); however, adverse events that required discontinuation of study anticoagulant occurred more ...
Heparin-induced thrombocytopenia (HIT) is one of the most serious adverse events associated with this drug. HIT is an immune-mediated, prothrombotic complication that occurs with unfractionated heparin (UFH) and to a lesser extent with low-molecular-weight heparin (LMWH) .
Other anticoagulation options such as low-molecular-weight heparin (LMWH), nafamostat mesilate (NM), Prostaglandin I2 (PGI2), and Regional-UFH are also available during CRRT [13,14,15,16]. Various anticoagulation options have been used during CRRT, but the efficacy and safety of these anticoagulants remain controversial.
Introduction Renal insufficiency increases the half-life of low molecular weight heparins (LMWHs). Whether continuous venovenous hemofiltration (CVVH) removes LMWHs is unsettled. We studied hemostasis during nadroparin anticoagulation for CVVH, and explored the implication of the endogenous thrombin potential (ETP). Methods This cross-over study, performed in a 20-bed teaching hospital ICU ...
Low-molecular-weight heparin can also effectively reduce the incidence of DVT. Moreover, studies have revealed different anticoagulant mechanisms for thrombin inhibition between unfractionated heparin and low-molecular-weight heparin [ 38 ].We attempted to perform a subgroup analysis on the two types of heparin.
Introduction Intensive care unit (ICU) patients are predisposed to thromboembolism. Routine prophylactic anticoagulation is widely recommended. Low-molecular-weight heparins, such as enoxaparin, are increasingly used because of predictable pharmacokinetics. This study aims to determine the subcutaneous (SC) dose of enoxaparin that would give the best anti-factor Xa levels in ICU patients ...