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NDT Advance Access originally published online on July 19, 2005
Nephrology Dialysis Transplantation 2005 20(10):2036-2042; doi:10.1093/ndt/gfi004
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org

Editorial Review

The heparins: all a nephrologist should know

Gerd R. Hetzel1 and Christoph Sucker2

1 Department of Nephrology and 2 Department of Hemostasis and Transfusion Medicine, Heinrich Heine University Medical Center, Duesseldorf, Germany

Correspondence and offprint requests to: PD Dr med. Gerd Rüdiger Hetzel, Department of Nephrology, University Medical Center, Moorenstrasse 5, D-40225 Düsseldorf, Germany. Email: hetzel@med.uni-duesseldorf.de

The first 150 words of the full text of this article appear below.



   Introduction
 
For decades, the use of unfractionated heparin (UFH) has been the basic principle of anticoagulation in patients at risk of or with established thromboembolic disorders. Nowadays, low molecular weight heparins (LMWHs) are increasingly used in this setting, because they are as effective but more convenient than UFH. The advantages of LMWHs include a longer elimination half-life, a lower incidence of heparin-induced thrombocytopenia type II (HIT-II), a lower risk of osteopenia and a more predictable anticoagulant effect that reduces the need for routine laboratory monitoring. Major clinical trials have demonstrated superior therapeutic efficacy in patients with acute coronary syndrome or venous thromboembolism compared with UFH [1–3]. However, most trials excluded subjects at risk for unpredictable pharmacokinetics such as the severely obese, the very elderly and patients suffering from chronic kidney disease stage IV and V. In renal failure, the elimination half-life of all LMWHs is significantly prolonged. Thus, severe . . . [Full Text of this Article]



   Chemical structure and mechanism of action
 


   Pharmacokinetics
 


   Clinical use of heparins in patients with renal failure
 


   The problem of HIT-II
 


   Conclusion
 

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[Abstract] [Full Text] [PDF]