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• W217287477 abstract "The authors postulate a “deep compartment” for enoxaparin. This is surprising in view of a distribution volume of some 5 liters and monophasic elimination (compare product information). Because of the structural differences of low molecular weight heparins, the pharmacokinetics of each low molecular weight heparin should be examined individually (1). Such substance specific studies in renal failure have been published for enoxaparin for a long time and have resulted in different dosage recommendations (1, 2, product information). Unfortunately, all this was ignored in the review article. For this reason, the article’s conclusions directly contradict the national and international licensing status of enoxaparin (for example, the US Food and Drug Administration [FDA]’s or the German Federal Institute for Drugs and Medical Devices [BfArM]’s).After repeated subcutaneous administration of the prophylactic dose (40 mg) in patients with a creatinine clearance <30 mL/min enoxaparin, the area under the plasma concentration time curve (AUC) is increased by an average of 65%. Because of this, the prophylactic dose in patients with severely restricted renal function, according to the existing risk of thromboembolism should not be higher than 20 mg or 30 mg. After administration of the therapeutic dose (1 mg/mg KG b.d.) in severely impaired renal function, the AUC has been shown to double. In the product information it is therefore recommended to reduce the dose by 50%. Registry data from 4687 patients with acute coronary syndrome without ST-segment elevation and moderately to severely impaired renal function imply that low molecular weight heparins (more than 80% of patients were treated with enoxaparin) result in less severe hemorrhages than treatment with unfractionated heparins (3). Especially in the situation of medication treatment in chronic renal failure, which poses particular difficulties for the treating physicians, all existing studies and the licensing status should be given enough attention when evaluating therapeutic options." @default.
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• W217287477 date "2011-02-18" @default.
• W217287477 modified "2023-09-24" @default.
• W217287477 title "Antithrombotic Prophylaxis and Therapy in Renal Failure" @default.
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• W217287477 cites W2146186028 @default.
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• W217287477 doi "https://doi.org/10.3238/arztebl.2011.0112b" @default.
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