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Review
. 2015 Mar 10:3:e835.
doi: 10.7717/peerj.835. eCollection 2015.

Efficacy and safety of low molecular weight heparin compared to unfractionated heparin for chronic outpatient hemodialysis in end stage renal disease: systematic review and meta-analysis

Ghanshyam Palamaner Subash Shantha  1 , Anita Ashok Kumar  1 , Mansha Sethi  2 , Rohit C Khanna  3 , Samir Bipin Pancholy  4
Affiliations
Review

Efficacy and safety of low molecular weight heparin compared to unfractionated heparin for chronic outpatient hemodialysis in end stage renal disease: systematic review and meta-analysis

Ghanshyam Palamaner Subash Shantha et al. PeerJ. .

Abstract

Background. Low molecular weight heparin (LMWH) is an effective anti-coagulant for thrombotic events. However, due to its predominant renal clearance, there are concerns that it might be associated with increased bleeding in patients with renal disease. Objectives. We systematically evaluated the efficacy and safety of LMWH compared to unfractionated heparin (UH) in end stage renal disease (ESRD) patients. Search Methods. Pubmed, Embase and cochrane central were searched for eligible citations. Selection Criteria. Randomized controlled trials, comparing LMWH and UH, involving adult (age > 18 years), ESRD patients receiving outpatient, chronic, intermittent hemodialysis were included. Data Collection and Analysis. Two independent reviewers performed independent data abstraction. I2 statistic was used to assess heterogeneity. Random effects model was used for meta-analysis. Results. Nineteen studies were included for systematic review and 4 were included for meta-analysis. There were no significant differences between LMWH and UFH for extracorporeal circuit thrombosis [risk ratio: 1 (95% CI [0.62-1.62])] and bleeding complications [risk ratio: 1.16 (95% CI [0.62-2.15])]. Conclusions. LMWH is as safe and effective as UFH. Considering the poor quality of studies included for the review, larger well conducted RCTs are required before conclusions can be drawn.

Keywords: Hemodialysis; Heparin; Meta-analysis; Thromboprophylaxis.

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Conflict of interest statement

The authors declare there are no competing interests.

Figures

Figure 1
Figure 1. Article flow diagram.
Details the process of study inclusion into the review
Figure 2
Figure 2. Forest plots: extracorporeal circuit thrombosis.
Forest Plots comparing LMWH Vs UH for extracorporeal circuit thrombosis.
Figure 3
Figure 3. Forest plots: bleeding complications.
Forest plots comparing LMWH Vs UH for bleeding complications.
See this image and copyright information in PMC

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