Influence of low molecular weight heparin compared to conventional heparin for anticoagulation during haemodialysis on low density lipoprotein subclasses

Wiemer, J.; Winkler, Karl; Baumstark, Manfred W.; März, Winfried; Scherberich, Jürgen E.

doi:10.1093/ndt/17.12.2231

Cited by 19 publications

(14 citation statements)

References 24 publications

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“…Heparin induces a significant rise in triglyceride levels [1]. In the study by Wiemer et al [17] dalteparin improved the metabolism of TG-rich lipoproteins probably due to preservation of lipoprotein lipase by LMW heparin as we observed in our study. We also observed positive correlations between TAFI and LDL and negative correlations between TAFI and HDL in patients given LMWHs and UFH.…”

Section: Discussionsupporting

confidence: 80%

Comparison of Effects of Different Heparins on Thrombin Activatable Fibrinolysis Inhibitor in Hemodialyzed Patients

Małyszko

Małyszko²,

Hryszko³

et al. 2004

Am J Nephrol

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Background: Thrombin activatable fibrinolysis inhibitor (TAFI) is a regulator of endogenous fibrinolysis. Heparin is used routinely during dialysis sessions to prevent clot formation in the extracorporeal circuit; therefore the aim of the study was to assess whether unfractionated heparin or low-molecular-weight heparins affect TAFI concentration and activity in hemodialyzed patients. Methods: Dalteparin (n = 16) or enoxaparin (n = 25) were administered before the second hemodialysis session in the week in a single dose, whereas unfractionated heparin (n = 18) was given first as a bolus, then in a pump. We also evaluated thrombin activity (thrombin-antithrombin complexes, prothrombin fragments 1 + 2), TAFI activator, thrombomodulin, a catalyzer of TAFI activation and a marker of endothelial cell injury, and the degree of plasmin generation (plasmin-antiplasmin complexes). Results: TAFI concentration, activity and markers of ongoing coagulation, i.e. prothrombin fragments 1 + 2 and thrombin-antithrombin complexes, were significantly higher in patients anticoagulated with unfractionated heparin when compared to both enoxaparin and dalteparin groups. Thrombin-antithrombin complexes, plasmin-antiplasmin complexes, prothrombin fragments 1 + 2, and thrombomodulin did not differ between patients anticoagulated with dalteparin and enoxaparin. Conclusions: Our results suggest that low-molecular-weight heparins influence TAFI and other hemostatic parameters in hemodialyzed patients to a lesser degree than unfractionated heparin. Increased TAFI is possibly due to thrombin appearance during hemodialysis with unfractionated heparin.

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Section: Discussionsupporting

confidence: 80%

Comparison of Effects of Different Heparins on Thrombin Activatable Fibrinolysis Inhibitor in Hemodialyzed Patients

Małyszko

Małyszko²,

Hryszko³

et al. 2004

Am J Nephrol

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“…Earlier studies showed that LMWH could substantially lower abnormally high serum triglycerides and lipoprotein pre-beta in chronic HD patients [12,16]. In hypertriglyceridemic HD patients, LMWH improved metabolism of triglyceride-rich lipoproteins, increased buoyant LDL, and decreased potentially atherogenic dense LDL [17]. Preservation of lipoprotein lipase by LMWH may be a possible mechanism to explain that finding.…”

Section: Discussionmentioning

confidence: 88%

Safety and Efficacy of Single Bolus Anticoagulation with Enoxaparin for Chronic Hemodialysis. Results of an Open-Label Post-Certification Study

Klingel

Schwarting

Lotz

et al. 2004

Kidney Blood Press Res

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Background: Low-molecular-weight heparin (LMWH) is supposed to be advantageous compared to unfractionated heparin for chronic hemodialysis (HD) with respect to lipid and bone metabolism, polymorphonuclear cell stimulation, induction of antibody-mediated thrombocytopenia, and aldosterone suppression. Due to longer biological half-life, LMWH offers the possibility of single bolus administration. Methods: To assess safety and efficacy of single bolus anticoagulation with enoxaparin for chronic HD, 781 stable HD patients from 79 German dialysis centers (mean age 62 years; 31% ESRD due to diabetes mellitus) were monitored by clinical and laboratory parameters for 32 weeks. Additionally, in a single dialysis center, 22 chronic HD patients were investigated by molecular markers of coagulation during chronic HD under conditions of single bolus or continuous anticoagulation regimens. Anti-Xa activity and the thrombin- antithrombin-III complex (TAT) were determined before the enoxaparin bolus, after 15 min, 2 h, and at the end of HD in venous and arterial blood lines. Results: Chronic HD was performed in 24,117 HD treatments with enoxaparin at a median dose of 70.1 IU/kg (5,000 IU median total dose) for single bolus anticoagulation. In 83.0% of HD treatments, enoxaparin was given as single bolus. In 98.3% of patients no adverse event was reported. No drug-related severe adverse event occurred. Significant clotting problems were observed in only 0.3% of HD treatments with single bolus anticoagulation. As assessed in 257 HD treatments, essentially identical anti-Xa levels were detected at the end of HD with single bolus (50 IU/kg) or continuous (mean total dose 43 IU/kg) anticoagulation regimens. Bolus anticoagulation resulted in higher TAT generation at the end of HD. However, this was not associated with increased macroscopic clot formation. Conclusion: Single bolus anticoagulation with enoxaparin was safe and effective for chronic HD. For a duration of 4 h HD, a median dose of 70 IU/kg can be recommended for regular use, which is in accordance with the manufacturer’s instructions for use of enoxaparin recommending a range of 50–100 IU/kg.

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“…However, low molecular weight heparins (LMWH) have the advantage over UFH in that they show less nonspecific binding to endothelium, macrophages, platelets and plasma proteins, a more predictable anticoagulant response, and usually have a low requirement for monitoring [3]. Furthermore, chronic UFH use may cause a number of untoward effects, such as heparin induced dyslipidemia [4,5], an increased risk of bleeding [6,7], allergic reactions [8], thrombocytopenia [9], osteoporosis [10] and aldosterone suppression [11]. …”

Section: Introductionmentioning

confidence: 99%

A multi-center, prospective, open-label, 8-week study of certoparin for anticoagulation during maintenance hemodialysis – the membrane study

et al. 2012

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BackgroundAdequate anticoagulation is prerequisite for effective hemodialysis to prevent clotting in the extracorporeal circuit. We aimed providing first data on the efficacy and safety of the low-molecular-weight heparin certoparin in this setting.MethodsMulticenter, open-label, 8-week trial. Patients received a single dose of 3,000 IU certoparin i.v. with additional titration steps of 600 IU and/or continuous infusion if necessary.Results120 patients were screened, 109 enrolled (median age 71; range 26–90 years) and 106 available for efficacy analyses. The percentage of unsatisfactory dialysis results at 8 weeks due to clotting or bleeding, was 1.9% (n = 2/106; 95% confidence interval [CI] 0.23–6.65%); no major bleeding. 1.9% had moderate/severe clotting in the lines/bubble catcher and 2.8% in the dialyser at week 8. 15.7 ± 14.3% of the dialysis filters’ visual surface area was showing redness. In subgroups of patients receiving median doses of 3000 ± 0, 3000 (2400–6000) and 4200 (3000–6600) IU, plasma aXa levels at baseline, 4 and 8 weeks were 0.24 [95%CI 0.21–0.27], 0.33 [0.27–0.40] and 0.38 [0.33–0.45] aXa IU/ml at 2 h. C48h was 0.01 [0.01–0.02] aXa IU at all visits. At baseline and 4 weeks AUC0-48h was 2.66 [2.19–3.24] and 3.66 [3.00–4.45] aXa IU*h/ml. In 3.0% of dialyses (n = 83/2724) prolonged fistula compression times were documented. Eight patients (7.34%) had at least one episode of minor bleeding. 4) 85.3% of patients had any adverse event, 9.2% were serious without suspected drug relation; and in 32 patients a drug-relation was suspected.ConclusionsCertoparin appears effective and safe for anticoagulation in patients undergoing maintenance hemodialysis.

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Influence of low molecular weight heparin compared to conventional heparin for anticoagulation during haemodialysis on low density lipoprotein subclasses

Abstract: In hypertriglyceridaemic HD patients, dalteparin improved metabolism of TG-rich lipoproteins, increased buoyant LDL and decreased potentially atherogenic dense LDL. Preservation of lipoprotein lipase by LMW heparin may be a possible mechanism to explain our findings.

Cited by 19 publications

References 24 publications

Comparison of Effects of Different Heparins on Thrombin Activatable Fibrinolysis Inhibitor in Hemodialyzed Patients

Comparison of Effects of Different Heparins on Thrombin Activatable Fibrinolysis Inhibitor in Hemodialyzed Patients

Safety and Efficacy of Single Bolus Anticoagulation with Enoxaparin for Chronic Hemodialysis. Results of an Open-Label Post-Certification Study

A multi-center, prospective, open-label, 8-week study of certoparin for anticoagulation during maintenance hemodialysis – the membrane study

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