Clinical Safety and Anticoagulation Efficacy of Low-Molecular-Weight Heparins in Chronic Hemodialysis Patients: A Single Medical Center Experience

Abstract

Background: In many countries low-molecular-weight heparins (LMWHs) are increasingly used for hemodialysis (HD). Low-range activated clotting time (ACT-LR) values and anti-Xa activity had been used to monitor the degree of anticoagulation caused by LMWH. However, the facilities are not easily available at most hospitals. Such data are limited in Taiwan. Methods: A total of 76 patients receiving maintenance HD were prospectively enrolled. The HD patients were randomized to receive either nadroparin or enoxaparin and checked the ACT-LR values and anti-Xa activity. We aimed to analyze ACT-LR values and anti-Xa activity along with the clotting of the dialyzer or bleeding events associated with two LMWHs after they were administered. We also aimed to determine the dose necessary to reach maximum safety and efficacy. Results: We found no significant differences in LMWH dosage, ACT-LR values, and anti-Xa activity between the two groups. There were no significant differences in bleeding/adverse events and extracorporeal circuit thrombosis between the two groups. Most of the bleeding and adverse events were subcutaneous minor bleeding. No major bleeding or mortality was found. We found significant differences in mean dosage, cost, bleeding/adverse effect, and extracorporeal circuit thrombosis between excessive and reduced nadroparin dosage groups. Conclusion: LMWH is not still routinely used due to its high cost in Taiwan. In our clinical experience, nadroparin and enoxaparin exhibited high levels of safety and efficacy in chronic HD patients. Reduced LMWHs dosage could promote patient's safety and decreased HD cost in HD patients with excessive dosage of LMWHs.

Anticoagulation in Chronic Hemodialysis: Progress Toward an Optimal Approach

“…Two additional studies compared tinzaparin with UFH and suggested comparable safety and comparable (26) or superior efficacy of tinzaparin (27). Two other studies which compared tinzaparin with dalteparin (28), and nadroparin with enoxaparin (29), showed no significant difference.…”

“…Seven clinical trials have evaluated the efficacy and safety of different LMWH with monitoring of ECC clotting by visual inspection, recording of bleeding episodes, and measurement of access compression times ( Table 2) (23)(24)(25)(26)(27)(28)(29). Three studies including stable HD patients investigated the efficacy and safety of each LMWH with weight-based dosing regimens (tinzaparin, enoxaparin) (23)(24)(25).…”

“…The anticoagulant effect of UFH has been assessed by two bedside tests (whole‐blood partial thromboplastin time [WBPTT] and activated clotting time [ACT]) for anticoagulation monitoring during HD, but they are expensive and may lack accuracy as heparin doses are low . Regarding LMWH, several studies investigated the reliability of point‐of‐care methods for measuring their anticoagulant effect . A low‐range activated clotting time (ACT‐LR) was used in a Taiwanese study which did not conclude on the success of such monitoring .…”

“…Regarding LMWH, several studies investigated the reliability of point‐of‐care methods for measuring their anticoagulant effect . A low‐range activated clotting time (ACT‐LR) was used in a Taiwanese study which did not conclude on the success of such monitoring . Addition of heparinase was used to determine anticoagulation levels with either the WBPTT or Hemochron aPTT assay; it may be used in a bedside setting as it can be completed within 10 minutes and is inexpensive .…”

Middle Molecular Weight Heparinyl Amino Acid Derivatives (MHADs) Function as Indirect Radical Scavengers <i>in Vitro</i>

“…To resolve this, we have synthesized MHADs to reduce the hemorrhage activity of HE with beneficial effects. Recently, low-molecular-weight heparins (LMWHs) are being used as anticoagulants and these are much safer than conventional HE [28]- [30]. In this study, we did not only try to decrease the molecular weight of HE, but also conjugate amino acids to reduce its high hemorrhagic tendency.…”