Comparison of low-molecular-weight heparin (enoxaparin sodium) and standard unfractionated heparin for haemodialysis anticoagulation

Saltissi, David; Morgan, C.; Westhuyzen, Justin; Healy, Helen

doi:10.1093/ndt/14.11.2698

Cited by 85 publications

(105 citation statements)

References 13 publications

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“…7,13,17 Filter life span was measured in hours and recorded at the end of CVVHD procedure. Major bleeding was defined as a fatal hemorrhagic event, bleeding in a critical organ such as intracranial, intra-abdominal or pulmonary, or the need for transfusion of two or more units of packed red blood cells.…”

Section: Discussionmentioning

confidence: 99%

“…28,29 Another important limitation to the use of LMWH has been their high cost in relation to UFH. 7,30 LMWH has been more widely tested in chronic hemodialysis 7,31,32 with few clinical trials assessing their efficacy and safety in CRRT. Some were randomized and controlled, but in general these studies involved a small number of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Patients in the enoxaparin group received intravenous enoxaparin at a dose of 40 mg every 12 hours (~0.5-0.7 mg/kg/12 hr), which is the recommended adjusted dose for patients with severe renal insufficiency. 7,13,14 The antithrombotic effect of enoxaparin was measured through plasma levels of anti-factor Xa activity, but this analysis was made retrospectively. Therapeutic levels of anti-factor Xa was defined as 0.5-1.0 UI/mL.…”

Section: Randomization and Interventionmentioning

confidence: 99%

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Enoxaparin versus unfractioned heparin as anticoagulant for continuous venovenous hemodialysis: a randomized open-label trial

et al. 2010

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Aim: In this study we aimed to compare the efficacy and safety of enoxaparin with unfractioned heparin (UFH) as anticoagulant for continuous venovenous hemodialysis (CVVHD). Methods: An open-label randomized controlled trial was carried out in an intensive care unit (ICU) where 40 patients with acute renal failure (ARF) who needed continuous renal replacement therapy were randomized to receive UFH (n = 21) or enoxaparin (n = 19). Coagulation parameters were evaluated, and antithrombotic activity of UFH was measured by activated partial thromboplastin time (aPTT) and for enoxaparin by anti-factor Xa activity. Primary outcomes were thrombosis of the extracorporeal circuit and bleeding, classified as major or minor. Results: Minor bleeding episodes were observed only in patients anticoagulated with enoxaparin (26 vs. 0%, p = 0.018). Comparing patients with or without bleeding after 24 hours of therapy, the level of anticoagulation tended to be higher (anti-factor Xa: 1.62 vs. 1.13 IU/mL, p = 0.09) and the platelet count to be lower [107 ± 53 vs. 229 ± 84 (×10 3 /μL), p = 0.09] in patients who bled, but without statistical difference. Filter life span of enoxaparin and UFH groups was similar (43 ± 15 vs. 52 ± 18 hr, p = 0.10), as well as the proportion of circuit clotting. Conclusion: Weightunadjusted enoxaparin in patients with ARF in CVVHD was associated with an increased rate of bleeding, a finding that addresses the need to adjust drug dose and to monitor anti-factor Xa activity during dialysis. No benefit to prolong dialysis circuit survival was found with enoxaparin. In patients who do not present contraindication for systemic anticoagulation, UFH remains an effective and low-cost option.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Randomization and Interventionmentioning

confidence: 99%

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Enoxaparin versus unfractioned heparin as anticoagulant for continuous venovenous hemodialysis: a randomized open-label trial

et al. 2010

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“…3,26 Previous reports indicate that a single bolus dose of enoxaparin (typically 0.8 mg/kg) was adequate for >98% patients dialyzing for up to 6 h. However, some patients required a second bolus dose; these patients were treated by giving a lower initial bolus (typically 0.4 mg/kg) followed by a second bolus injection after 3 h. 24 In our study, a single bolus dose of enoxaparin (average 0.60 mg/kg or 62.5 IU/kg) was adequate (13/14) for >92% of patients during HD. Only one patient needed the second bolus dose.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7] Other advantages include low incidence rates of heparin-induced bleeding, 8 osteoporosis, 9 thrombocytopenia, 10 and lipid abnormalities. 11 degree of anticoagulation of LMWHs.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2011

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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.

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Heparin and related substances for delaying the progression of diabetic kidney disease

Xie¹,

Yang²,

Fan³

et al. 2007

Cochrane Database of Systematic Reviews

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Comparison of low-molecular-weight heparin (enoxaparin sodium) and standard unfractionated heparin for haemodialysis anticoagulation

Abstract: This study suggests that a single-dose protocol of Clexane is an effective and very convenient alternative to sodium heparin, but currently direct costs are about 16% more. We recommend an initial dose of 0.70 mg/kg.

Cited by 85 publications

References 13 publications

Enoxaparin versus unfractioned heparin as anticoagulant for continuous venovenous hemodialysis: a randomized open-label trial

Enoxaparin versus unfractioned heparin as anticoagulant for continuous venovenous hemodialysis: a randomized open-label trial

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

Heparin and related substances for delaying the progression of diabetic kidney disease

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