Heparin-induced thrombocytopenia among incident hemodialysis patients anticoagulated with low molecular weight heparin: A single-center retrospective study

Doi, Yasufumi; Koga, Kenichi; Sugioka, Sayaka; Inoue, Yuki; Arisato, Tetsuya; Nishioka, Keisuke; Ishihara, Takeshi; Sugawara, Akira

doi:10.1016/j.nefro.2020.05.012

Cited by 4 publications

(4 citation statements)

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“…Moreover, the authors suggested that the combined effect of UFH used in heparin-lock of the catheter at the end of each HD session (linked to suspected catheter leak) and LMWH used as an anticoagulant during HD session could be an additional risk of the observed thrombocytopenia in this group. This is in settlement with Doia and his colleagues, 2020 reported that catheterrelated infection triggered the development of HIT and concluded that central venous catheter at the hemodialysis therapy might be a risk for the development of HIT [19]. Furthermore, the central venous catheter itself could be a contributor to increased inflammation independently of infection [24].…”

Section: Discussionsupporting

confidence: 72%

“…One Japanese study [19] found a mild decrease in heparin-induced thrombocytopenia (HIT) incidence with LMWH which was 0.6% (0% in patients without central venous catheter, 2.3% in patients with central venous catheter), compared to previous reports with UFH which were 3.9% and 1.0%, respectively [20] and [21]. In the existing study, the group of patients with blood platelets of less than 150,000 /mm3 showed statistically significant improvement in platelet number with shifting to enoxaparin.…”

Section: Discussionmentioning

confidence: 99%

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Effects of Changing Anticoagulation with Unfractionated Heparin into Enoxaparin in Hemodialysis Patients:Prospective Non Randomized Unicentre Study

Megahed

Tawfik

Hles

et al. 2021

AJMAH

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Background: Maintaining the patency of the extracorporeal circuit (ECC) is required. The cost and long-term effect of anticoagulants on hemodialysis (HD) patients' parameters are still matters of concern. We aimed to study the effect of shifting to enoxaparin instead of unfractionated heparin (UFH) during HD and evaluate its efficacy, safety, and benefits. Design and methodology: This study was conducted at Arar hospital, Kingdom of Saudi Arabia (KSA), and included 86 end-stage renal disease (ESRD) patients on HD for six months starting from October 2017. All patients had been on UFH as an anticoagulant during hemodialysis sessions before they were shifted to equivalent doses of enoxaparin sodium (Clexan®) as a therapeutic upgrade to start with. The patients’ files were examined retrospectively for the period of UFH therapy and then all patients were observed prospectively for at least 6 months while on Clexane. The occurrence of clotting in the dialysis sets were recorded and the need for urgent HD for each patient and the reasons. Results: There was a reduction of filter clots even with the reduction of enoxaparin dose. There was a significant reduction of mean cholesterol, calcium, phosphorus, sodium, chloride, and serum osmolality. We found a significant reduction of pre-dialysis potassium among those who presented with a pre-dialysis potassium of higher than 5.5 mg/dl during the enoxaparin phase. Patients, who had thrombocytopenia while on UFH; showed improvement in platelet count after the shift to enoxaparin. However, patients who had platelet count lowered than 150000/mm3 6 months after having been shifted to enoxaparin; many of them received HD through a permanent catheter. No patients had a three-fold increase of normal values (3ULN) of liver function tests whether being on heparin or enoxaparin. Conclusion: Low molecular weight heparin (LMWH) could be more efficacious and safe than UFH with the improvement of some variables in HD patients.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Effects of Changing Anticoagulation with Unfractionated Heparin into Enoxaparin in Hemodialysis Patients:Prospective Non Randomized Unicentre Study

Megahed

Tawfik

Hles

et al. 2021

AJMAH

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“…The use of heparin for hemodialysis (HD) requires the injection of a heparin solution in the patient’s blood [ 11 , 12 , 13 ] or/and using heparin-covered HD membranes and other parts of dialysis equipment [ 14 , 15 , 16 ]. Independently of the use method, severe health problems may arise due to with the use of heparin, such as heparin-induced thrombocytopenia (HIT) [ 17 , 18 , 19 , 20 , 21 , 22 ], hypertriglyceridemia [ 23 ], anaphylaxis [ 24 ], bone mineral disease [ 25 ], hyperkalemia [ 26 ], catheter-related sepsis [ 27 ], skin necrosis [ 28 ], etc. The most severe side effect is HIT, which results is blood clotting [ 19 , 29 ].…”

Section: Introductionmentioning

confidence: 99%

“…The negatively charged surfaces are believed to be associated with the increased adsorption of proteins and overall fouling that can be considered as the first step to complement activation with further fibrosis [ 30 ]. The presence of heparin is intended to reduce this process or even to prevent it, but in vivo HD sessions indicate that heparin does not guarantee the exclusion of blood clotting and related health problems [ 17 , 19 , 20 , 21 , 22 , 24 , 26 , 28 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ].…”

Section: Introductionmentioning

confidence: 99%

Heparin-Immobilized Polyethersulfone for Hemocompatibility Enhancement of Dialysis Membrane: In Situ Synchrotron Imaging, Experimental, and Ex Vivo Studies

et al. 2023

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The goal of the current study is to enhance the hemocompatibility of polyethersulfone (PES) membranes using heparin immobilization. Heparin was immobilized covalently and via electrostatic interaction with the positively charged PES surface (pseudo-zwitterionic (pZW) complex) to investigate the influence of each method on the membrane hemocompatibility. In situ synchrotron radiation micro-computed tomography (SR-µCT) imaging, available at the Canadian Light Source (CLS), was used to critically assess the fibrinogen adsorption to the newly synthesized membranes qualitatively and quantitatively using an innovative synchrotron-based X-ray tomography technique. The surface roughness of the synthesized membranes was tested using atomic force microscopy (AFM) analysis. The membrane hemocompatibility was examined through the ex vivo clinical interaction of the membranes with patients’ blood to investigate the released inflammatory biomarkers (C5a, IL-1α, IL-1β, IL-6, vWF, and C5b-9). The presence and quantitative analysis of a stable hydration layer were assessed with DSC analysis. Surface modification resulted in reduced surface roughness of the heparin-PES membrane. Both types of heparin immobilization on the PES membrane surface resulted in a decrease in the absolute membrane surface charge from −60 mV (unmodified PES) to −13 mV for the pZW complex and −9.16 mV for the covalently attached heparin, respectively. The loss of human serum fibrinogen (FB) was investigated using UV analysis. The PES membrane modified with the heparin pseudo-ZW complex showed increased FB retention (90.5%), while the unmodified PES membrane and the heparin covalently attached PES membrane exhibited approximately the same level of FB retention (81.3% and 79.8%, respectively). A DSC analysis revealed an improvement in the content of the hydration layer (32% of non-freezable water) for the heparin-coated membranes compared to the unmodified PES membrane (2.84%). An SR-µCT analysis showed that the method of heparin immobilization significantly affects FB adsorption distribution across the membrane thickness. A quantitative analysis using SR-µCT showed that when heparin is attached covalently, FB tends to be deposited inside the membrane pores at the top (layer index 0–40) membrane regions, although its content peak distribution shifted to the membrane surface, whereas the unmodified PES membrane holds 90% of FB in the middle (layer index 40–60) of the membrane. The ex vivo hemocompatibility study indicates an improvement in reducing the von Willebrand factor (vWF) for the heparin pseudo-ZW PES membrane compared to the covalently attached heparin and the untreated PES.

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Cisplatin/parnaparin-sodium

2022

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Heparin-induced thrombocytopenia among incident hemodialysis patients anticoagulated with low molecular weight heparin: A single-center retrospective study

Cited by 4 publications

References 9 publications

Effects of Changing Anticoagulation with Unfractionated Heparin into Enoxaparin in Hemodialysis Patients:Prospective Non Randomized Unicentre Study

Effects of Changing Anticoagulation with Unfractionated Heparin into Enoxaparin in Hemodialysis Patients:Prospective Non Randomized Unicentre Study

Heparin-Immobilized Polyethersulfone for Hemocompatibility Enhancement of Dialysis Membrane: In Situ Synchrotron Imaging, Experimental, and Ex Vivo Studies

Cisplatin/parnaparin-sodium

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