Low-Molecular-Weight Heparin Fraxiparin® in Chronic Hemodialysis

Morinière, P.; Dieval, J; Bayrou, B; Roussel, Bertrand; Renaud, H; Fournier, A; Delobel, J

doi:10.1159/000169605

Cited by 13 publications

(7 citation statements)

References 9 publications

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“…As the doses of nadroparin postulated in our study were lower than those used in others, our anti‐Xa values at the end of the HD sessions were also lower than those found by other authors 35–37,40,41 …”

Section: Discussioncontrasting

confidence: 70%

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The individually optimized bolus dose of nadroparin is safe and effective in diabetic and nondiabetic patients with bleeding risk on hemodialysis

Šain

Ljutić

Kovačić

et al. 2011

Hemodialysis International

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The risk of bleeding is a well-known complication in patients on hemodialysis (HD). The aim of this prospective study was to determine the lowest single bolus dose of low-molecular-weight heparin nadroparin for safe and effective HD in patients with a bleeding risk. Forty HD patients were divided into 4 subgroups with 10 participants (diabetics with and without a bleeding risk, nondiabetics with and without a bleeding risk). The actual starting bolus dose was decreased by 25% after the initial 4 weeks, further decreased by 25% of the starting dose after 4 weeks, and changed due to extracorporeal circuit clotting in the last 4 weeks. The parameters of coagulation were measured at the beginning, after 2 and 4 h of HD sessions. A significant reduction of nadroparin (first vs. last HD session) was observed in: diabetics with a bleeding risk (49.66 ± 12.33 vs. 28.78 ± 9.60 IU/kg/HD; P<0.001), diabetics without a bleeding risk (50.70 ± 15.23 vs. 33.95 ± 16.97 IU/kg/HD; P<0.001), and nondiabetics with a bleeding risk (61.25 ± 18.68 vs. 32.96 ± 10.06 IU/kg/HD; P<0.001). Altogether, the reduction of the nadroparin dose in these groups was 42.05%; 33.04%, and 46.19%, respectively. Although anti-Xa at hour 4 at the end of the study was <0.4 IU/mL in our diabetic and nondiabetic patients without a risk of bleeding, serious clottings in the extracorporeal circuit and vascular access thromboses were not found. This study demonstrated for the first time that individually optimized doses of nadroparin are sufficient for safe and effective HD in patients with a bleeding risk.

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Section: Discussioncontrasting

confidence: 70%

“…Different single bolus doses of nadroparin (in IU/HD) were used for HD by other authors: Güz et al 39 7500 IU/HD, Moriniere et al 40 5000 IU/HD, and Liu and colleagues 4100 IU/HD 41 . In the study of Šabovič et al, nadroparin was used in regular doses (3800–7600 IU anti‐Xa) 21 …”

Section: Discussionmentioning

confidence: 99%

The individually optimized bolus dose of nadroparin is safe and effective in diabetic and nondiabetic patients with bleeding risk on hemodialysis

Šain

Ljutić

Kovačić

et al. 2011

Hemodialysis International

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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

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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.

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“…In 1997, we decided, based on supportive literature data [6][7][8] , to use LMWHs as anticoagulant in our HD patients. We conducted a prospective clinical study in 3 phases.…”

Section: Methodsmentioning

confidence: 99%

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

Bernieh

Boobes²,

Hakim³

et al. 2009

Blood Purif

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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.

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Low-Molecular-Weight Heparin Fraxiparin® in Chronic Hemodialysis

Cited by 13 publications

References 9 publications

The individually optimized bolus dose of nadroparin is safe and effective in diabetic and nondiabetic patients with bleeding risk on hemodialysis

The individually optimized bolus dose of nadroparin is safe and effective in diabetic and nondiabetic patients with bleeding risk on hemodialysis

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

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

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