Laboratory control of minimal heparinization during haemodialysis in patients with a risk of haemorrhage

Häfner, Gerd; Klingel, Reinhard; Wandel, E; Ehrenthal, W.; Konheiser, U.; Lotz, Johannes; Köhler, Hans; Prellwitz, W.

doi:10.1097/00001721-199404000-00010

Cited by 11 publications

(13 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A variation of 620% above normal was regarded as pathological change of the respective parameter. The area under the curve (AUC) versus time of dialysis represents the appropriate parameter for the assessment of hemocompatibility parameters, as were the generation of procoagulatory molecular markers during time of dialysis and were calculated as previously described [9,11]. The statistical significance was defined as p !…”

Section: Discussionmentioning

confidence: 99%

“…Blood samples to determine anti-Xa activity and TAT were taken from the arterial and venous blood line before the enoxaparin bolus, after 15 min, at 2 h, and at the end of HD. Median and mean duration of dialysis sessions was 4 h. Anti-Xa activity was determined with Coatest ® LMW Heparin/Heparin (Chromogenix, Monza, Italy) and TAT with the Enzygnost ® TAT micro (Behringwerke AG, Marburg, Germany) following the manufacturer's instructions and as otherwise described [9,10].…”

Section: Molecular Characterization Of Enoxaparin Anticoagulationmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Molecular Characterization Of Enoxaparin Anticoagulationmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…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).…”

Section: Study Identification and Selectionmentioning

confidence: 99%

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

Lim¹,

Cook²,

Crowther³

2004

Journal of the American Society of Nephrology

154

128

View full text Add to dashboard Cite

Abstract. Low molecular weight heparins (LWMH) are the preferred initial treatment for many thromboembolic disorders but are renally excreted and relatively contraindicated in patients with renal failure because of concerns of increased bleeding risks. The purpose of this study was to evaluate the safety and efficacy of LMWH compared with unfractionated heparin (UFH) for preventing thrombosis of the extracorporeal dialysis circuit. Studies were identified with the use of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and FirstSearch; reference lists were reviewed; and pharmaceutical companies were contacted. Randomized, controlled trials that compared an LMWH with another anticoagulant during hemodialysis in patients with ESRD and reported at least one of bleeding, extracorporeal circuit thrombosis, or anti-Xa levels were chosen. Two reviewers independently extracted data on methodologic quality, study design, clinical outcomes, and anti-Xa levels. Seventeen trials were included in this systematic review, 11 of which were included in the meta-analysis. It was found that LMWH did not significantly affect the number of bleeding events (relative risk, 0.96; 95% confidence interval [CI], 0.27 to 3.43), bleeding assessed by vascular access compression time (weighted mean difference, Ϫ0.87; 95% CI, Ϫ2.75 to 1.02), or extracorporeal circuit thrombosis (relative risk, 1.15; 95% CI, 0.70 to 1.91) as compared with UFH.

show abstract

“…Mean hematocrit was 0.36 (SEM 0.04). The area under the curve (AUC) of neutrophil elastase and complement factor C3a versus time of dialysis represents the best parameter for the generation of each factor during time of dialysis and was calculated as described before [18].…”

Section: Blood Sampling and Laboratory Parametersmentioning

confidence: 99%

“…AUC of both parameters can be regarded as suitable hemocompatibility markers superior to the comparison of values at single times [18,21]. Irrespective of the higher values of C3a at 15 min, accompanied with the increase of neutrophil elastase, and the more pronounced drop of white blood cells for F-60S, there was no statistically significant difference between the calculated AUC of complement generation or neutrophil elastase release of both dialyzers.…”

Section: Blood Compatibilitymentioning

confidence: 99%

Enhanced Functional Performance Characteristics of a New Polysulfone Membrane for High-Flux Hemodialysis

Klingel

Ahrenholz²,

Schwarting

et al. 2002

Blood Purif

View full text Add to dashboard Cite

Elimination of uremic solutes with molecular weights up to 60 kD, without significant loss of albumin is an important therapeutic goal to optimize outcomes in chronic hemodialysis patients. To characterize a newly developed polysulfone dialyzer (APS-650) a comparative analysis was performed with a highly advanced polysulfone dialyzer (F-60S) including 22 stable chronic hemodialysis patients. Diffusive clearances were determined, and albumin loss was calculated. The elimination profile of uremic solutes up to 32.0 kD was assessed in vivo by sieving coefficients, clearances, and reduction ratios of β₂-microglobulin (11.8 kD), myoglobin (17.2 kD), prolactin (23.0 kD), and α₁-microglobulin (32.0 kD). Hemocompatibility was tested in serial measurements of total white blood cell count, platelet count, C3a, and neutrophil elastase. No significant albumin loss was detected. Significantly higher sieving coefficients, clearances, and reduction ratios for proteins with molecular weight up to 32.0 kD were demonstrated with the newly developed polysulfone membrane. Both polysulfone membranes were equal concerning hemocompatibility parameters. The APS-650 dialyzer allowed optimized hemodialysis treatment with respect to clearance of medium-sized uraemic solutes by high-flux dialysis.

show abstract

Laboratory control of minimal heparinization during haemodialysis in patients with a risk of haemorrhage

Cited by 11 publications

References 0 publications

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

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

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

Enhanced Functional Performance Characteristics of a New Polysulfone Membrane for High-Flux Hemodialysis

Contact Info

Product

Resources

About