Lim Wendy
Department of Medicine, Division of Hematology-Thromboembolism, McMaster University, St Joseph's Hospital, Hamilton, ON, Canada.
Intern Emerg Med. 2008 Dec;3(4):319-23. doi: 10.1007/s11739-008-0164-9. Epub 2008 Jun 18.
Low-molecular-weight heparin (LMWH) has largely replaced unfractionated heparin for the treatment of venous thromboembolism. The predictable anticoagulant effect of LMWH is seen across almost all patient populations, with few exceptions. However, because LMWH is primarily eliminated through the kidneys, patients with renal insufficiency are at risk of LMWH accumulation and bleeding complications. The risk of LMWH accumulation and bleeding is dependent on several factors including the degree of renal insufficiency, dose and type of LMWH. These risks are greatest when therapeutic doses of LMWH are used in patients with creatinine clearance less than 30 ml/min. Prophylactic dose LMWH does not appear to be associated with an increased bleeding risk, but has not been evaluated in large trials. LMWHs with a higher molecular weight may be less prone to accumulation and bleeding. LMWH must be used carefully in patients with renal insufficiency, particularly in those with severe renal impairment.
低分子量肝素（LMWH）在治疗静脉血栓栓塞方面已在很大程度上取代了普通肝素。几乎在所有患者群体中都可见到LMWH可预测的抗凝作用，仅有少数例外。然而，由于LMWH主要通过肾脏清除，肾功能不全的患者有LMWH蓄积和出血并发症的风险。LMWH蓄积和出血的风险取决于几个因素，包括肾功能不全的程度、LMWH的剂量和类型。当肌酐清除率低于30 ml/min的患者使用治疗剂量的LMWH时，这些风险最大。预防性剂量的LMWH似乎与出血风险增加无关，但尚未在大型试验中进行评估。分子量较高的LMWH可能较不易发生蓄积和出血。肾功能不全的患者必须谨慎使用LMWH，尤其是那些有严重肾功能损害的患者。
