Long-Term Use of Low-Molecular-Weight Heparin in Hemodialysis Patients: A 7-Year Experience

Abstract

Background: Low-molecular-weight-heparin (LMWH) is not routinely used as anticoagulant in hemodialysis (HD). The ideal dose and the safety of long-term use are not known. Methods: A prospective three-phase interventional study. Phase 1 involved dose titration, phase 2 safety and efficacy and phase 3 routine practice. Results: During 7 years of the use of the LMWH enoxaparin (EN), 236 patients were treated with a total number of 60,987 HD sessions. The mean dose used during the titration phase was 0.43 ± 0.16 mg/kg/session, which was subsequently reduced in phase 3 to 0.36 ± 0.14 mg/kg/session. The long-term effects of EN on the platelet count and lipid profile were comparable to unfractionated heparin. Conclusion: The long-term use of LMWH (EN) with a reduced dose in HD is practical and safe.

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

“…[8][9][10][11] LMWHs are routinely used in HD in European clinical settings. 23 Bernieh et al 24 reported that enoxaparin had been routinely used for 7 years. Lim et al 7 reported about the safety and efficacy of LMWHs for use in HD in patients with end-stage renal failure.…”

“…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.…”

“…12,28,29 The previous reports also revealed that the optimum enoxaparin dosage was between 0.36 and 0.7 mg/kg in HD patients. 24,30 In our study, LMWH (0.4 cc) was given if body weight was <60 kg, or 0.6 cc if body weight was >60 kg. The dosage of nadroparin necessary to prevent clotting of the extracorporeal circuit was an average of 67.5 ± 19.3 IU/kg or 3937.9 ± 970.8I U/session.…”

“…The results were similar to previous reports. 24,30 In excessive LMWHs dosage portion, 85.7% (12/14) patients had ACT-LR exceeding baseline 2.5-fold and anti-Xa level exceeding 0.5 U/mL after 1 or 2 h of HD. It is of interest that two patients (one using nadroparin, one using enoxaparin) had clinical bleed but ACT-LR less than 150 s and anti-Xa level not over 0.5 U/mL after 1 or 2 h of HD.…”

“…Vavenport 23 reported that chronic HD patients routinely use enoxaparin and experienced only one bleeding episode in 2 years. Bernieh et al 24 reported that 0.4% bleeding episodes were observed in patients that were given enoxaparin. Saltissi et al 3 also reported that 33.3% (12/36) of bleeding episodes including 1 severe and 11 moderate were observed in patients with an initial dose of 1 mg/kg enoxaparin that was then titrated to 0.69 mg/kg.…”