Long-Term Intraperitoneal Application of Low Molecular Weight Heparin in a Continuous Ambulatory Peritoneal Dialysis Patient with Deep Vein Thrombosis

Schrader, J; Tönnis, H. J.; Scheler, F.

doi:10.1159/000183639

Cited by 18 publications

(11 citation statements)

References 11 publications

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“…The only report about the systemic effect of low-molecular-weight heparin (LMWH) belongs to Schrader et al [1]who have administered high-dose intraperitoneal LMWH (8,000 anti-Xa activity) for 6 months in 1 patient. In all studies, anti-FXa activity is measured in order to document systemic effect of heparin.…”

Section: Introductionmentioning

confidence: 99%

Effect of Intraperitoneal Administration of Low-Molecular-Weight Heparin on Plasma Tissue Factor Pathway Inhibitor Levels in CAPD Patients

Demırkan

Akarsu²,

Sifil³

et al. 2002

Nephron

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We investigated the systemic effect of intraperitoneal low-molecular-weight heparin (LMWH) in continuous ambulatory peritoneal dialysis (CAPD) patients by measuring plasma total tissue factor pathway inhibitor (TFPI) levels, regarding the fact that the levels of plasma TFPI increases 2- to 4-fold after subcutaneous and intravenous administration of unfractioned heparin or LMWH. Eleven men and 6 women who had been on CAPD for 32 ± 26 months and 15 healthy controls were included in the study. After administration of intraperitoneal enoksiparin in dialysate, plasma samples were obtained 4 h later. TFPI levels were significantly higher in CAPD patients (207.8 ± 55 ng/ml) compared to the healthy subjects (72.5 ± 29 ng/ml) (p < 0.0001). Both TFPI levels (225.9 ± 47 vs. 207.8 ± 55 ng/ml) (p < 0.54) and plasma factor Xa (anti-FXa assay) (0.097 ± 0.14 vs. 0.093 ± 0.16 U/ml) (p < 0.54) levels did not show any statistical difference before and after intraperitoneal administration of LMWH. By these findings we might suggest that intraperitoneal LMWH does not have any systemic effect.

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Section: Introductionmentioning

confidence: 99%

Effect of Intraperitoneal Administration of Low-Molecular-Weight Heparin on Plasma Tissue Factor Pathway Inhibitor Levels in CAPD Patients

Demırkan

Akarsu²,

Sifil³

et al. 2002

Nephron

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“…Fur thermore, Schrader et al [7] reported that in CAPD pa tients plasma heparin activity and APTT increased by intraperitoneally administered low-molecule-weight he parin. FPA is a specific marker of fibrinogen cleavage by thrombin.…”

Section: Discussionmentioning

confidence: 99%

“…However, recently, Canavese et al [6] and Schrader et al [7] reported that heparin was able to pass through the peritoneal membrane in CAPD animal models and CAPD patients.…”

Section: Introductionmentioning

confidence: 99%

Inhibitory Effect of Heparin and/or Antithrombin III on Intraperitoneal Fibrin Formation in Continuous Ambulatory Peritoneal Dialysis

Tabata

Shimada²,

Emoto³

et al. 1990

Nephron

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The intraperitoneal fibrin formation and its inhibition by intraperitoneal heparin and/or antithrombin III (AT III) were examined in 8 patients on continuous ambulatory peritoneal dialysis (CAPD). With 1,000 and 2,000 U/L of heparin added to inflow dialysate, the concentration of fibrinopeptide A (FPA) in plasma decreased from 39.43 ± 5.30 (mean ± SEM) to 8.00 ± 2.20 and to 0.74 ± 0.12 ng/ml, respectively. The FPA concentration in outflow dialysate decreased from 34.20 ± 5.75 to 12.94 ± 2.10 ng/ml (1,000 U/l of heparin) and to 4.54 ± 0.79 ng/mg (2,000 U/l of heparin). The AT III concentration was 0.47 ± 0.07 mg/dl in dialysate and that in plasma was 24.20 ± 2.76 mg/dl. With 100 U/bag of AT III added to inflow dialysate, the AT III concentration increased from 0.47 ± 0.07 to 3.36 ± 0.17 mg/dl in outflow dialysate but did not increase in plasma. The inhibition of fibrin formation of intraperitoneal heparin was increased by addition of AT III without a systemic inhibitory effect on fibrin formation. These data suggest that intraperitoneal administration of heparin without AT III would be sufficient for the purpose of preventing fibrin formation in CAPD patients without any trouble, and additional AT III might increase inhibitory effect of heparin.

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“…its intraperitoneal use. is shown in figure 7 and has been published recently [28]. Several authors have shown that the intraperitoneal application of UF heparin does not.…”

Section: Peritoneal Dialysismentioning

confidence: 93%

Comparison of Unfractionated Heparin and Low Molecular Weight Heparin during Long-Term Use in Chronic Haemodialysis and Haemofiltration Patients

Schrader¹,

Kandt²,

Zürcher³

et al. 1986

Pathophysiol Haemos Thromb

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Antithrombotic activity, necessary doses and effects on coagulation and lipid variables of the low molecular weight heparin derivative Fragmin were compared to unfractionated (UF) heparin in long-term multicentre trials. Results of more than 10,000 dialyses are reported. On the basis of preliminary studies, UF heparin and Fragmin doses were used that lead to anti-Xa activities of more than 0.5 U/ml. With this dose, sufficient antithrombotic activity was achieved with both heparins. Bleeding complications were not noticed. Partial thromboplastin time (PTT) and thrombin time were only marginally increased by Fragmin (5–8 s) in contrast to UF heparin (PTT 90–120 s, thrombin time 230–260 s). Surprisingly, the elevated levels of factor VIII strongly decreased during the 6-month treatment period with Fragmin and increased again during the following 6-month treatment period with UF heparin. Creatinine, urea, haemoglobin and transaminases did not change in both heparin groups: this excluded reduced dialysis efficiency or occult blood loss. Additionally, 15 patients with acute renal failure and high bleeding risk were dialysed with low doses of Fragmin (anti-FXa: 0.2–0.3 U/ml). No severe bleeding occurred. A continuous ambulant peritoneal dialysis patient with deep vein thrombosis was treated effectively with intraperitoneal application of Fragmin for 6 months without any problems.

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Long-Term Intraperitoneal Application of Low Molecular Weight Heparin in a Continuous Ambulatory Peritoneal Dialysis Patient with Deep Vein Thrombosis

Cited by 18 publications

References 11 publications

Effect of Intraperitoneal Administration of Low-Molecular-Weight Heparin on Plasma Tissue Factor Pathway Inhibitor Levels in CAPD Patients

Effect of Intraperitoneal Administration of Low-Molecular-Weight Heparin on Plasma Tissue Factor Pathway Inhibitor Levels in CAPD Patients

Inhibitory Effect of Heparin and/or Antithrombin III on Intraperitoneal Fibrin Formation in Continuous Ambulatory Peritoneal Dialysis

Comparison of Unfractionated Heparin and Low Molecular Weight Heparin during Long-Term Use in Chronic Haemodialysis and Haemofiltration Patients

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