Anwendung von niedermolekularem Heparin bei Hämodialysepatienten

Abstract

Low-molecular-weight (LMW) heparin has been compared to standard unfractionated (UF) heparin in a total of 49 patients on hemodialysis and hemofiltration in order to determine the necessary therapeutic dose and its effect on the coagulation system. A LMW heparin dose corresponding to 50% of the normal UF heparin dose was found to produce similar plasma heparin levels (anti-FXa-U/ml) in particular on minimal heparinization. At higher doses, UF heparin produced a more marked increase in plasma-heparin than did LMW heparin. Highly significant differences were found between UF and LMW heparin in their effects on PTT and thrombin time. Partial thromboplastin time (PTT) increased under UF heparin by an average of 120 s whereas LMW heparin only produced an increase of 5-7 s. Thrombin time was increased by 250-280 s under UF heparin and by 5-8 s under LMW heparin. With this LMW heparin dose of 50% of the UF heparin dose, no thrombosis of the extracorporal system occurred and no macroscopic detectable thrombotic material was found in the dialyzers or filters. No significant differences were observed between the effects of UF and LMW heparin on Factor VIII activity and fibrin monomers, so that a difference in coagulation activation between the two heparins can be excluded. Furthermore, there were no changes in thromboplastin time according to Quick, fibrinogen, antithrombin III, plasminogen, and a2-antiplasmin.(ABSTRACT TRUNCATED AT 250 WORDS)

Safety and Efficacy of Low Molecular Weight Heparins for Hemodialysis in Patients with End-Stage Renal Failure

“…We excluded 114 studies after title and abstract screening using inclusion and exclusion criteria. Of the 33 remaining studies, 15 did not meet the inclusion criteria after article review: 14 studies were not randomized (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25), and one study used a historical control UFH arm (26). One study was excluded because all patients had underlying hypercoagulability (27).…”

Comparison of Unfractionated Heparin and Low Molecular Weight Heparin during Long-Term Use in Chronic Haemodialysis and Haemofiltration Patients

“…The results of the dose-finding/safety studies have already been published [25,26] and are therefore only summarized here: when comparable anti-FXa activity was in duced, Fragmin and UF heparin were shown to have equivalent antithrombotic activity. In contrast to UF heparin.…”

Clinical Potential of Low Molecular Weight Heparins

“…Schrader and coworkers 21,22 investigated the LMWH Fragmin (Kabi 2165) for hemodialysis. They compared it with standard heparin in patients with chronic as well as acute renal failure.…”

“…They have summarized the results of a number of clinical trials. 21,22 They conclude that a LMWH (Fragmin) level of 0.5 anti-Xa U/ml was a minimum requirement to avoid fibrin deposition in the dialyzer. An initial dose of 30 to 40 anti-Xa U/kg body weight and 10 to 15 anti-Xa U/hour was satisfactory in the average case.…”