Standard Heparin versus Low-Molecular-Weight Heparin

Abstract

Background: To compare standard heparin (SH) and low molecular weight heparin (LMWH) in terms of anticoagulation, platelet activation and lipid metabolism, we selected 54 patients who had been on 4-hour hemodialysis three times weekly for at least 12 months, without bleeding disorders or dyslipidemic diseases. 28 were on hemodialysis with Polysulfone low-flux, 26 were on hemodiafiltration with Polysulfone high-flux. All patients underwent EPO. Methods: During the first 18 months, we administered SH 1,500 IU on starting dialysis and 1,500 ± 500 IU in continuous intradialytic infusion per session. In the following 18 months, we administered LMWH 64.6 IU/kg on starting dialysis in a single arterious bolus. We assessed aPTT, anti-factor Xa activity, TAT and FPA, β-TG and PF4. Blood samples were taken monthly at times 0, 30, 60, 180 and 240 min, as well as 1, 4 and 20 h after dialysis end. Predialysis cholesterol, HDL, LDL, triglycerides and lipoprotein(a) were checked monthly. Results: During both LMWH and SH sessions no clotting or major bleeding complications were observed. APTT with LMWH was lower than that found with SH (p < 0.001); aFXa using LMWH was higher than when using SH (p < 0.001); TAT and FPA were lower in LMWH sessions (p < 0.01) than in SH sessions. We also detected lower β-TG (p < 0.05) and PF4 levels (p < 0.05) using LMWH than using SH. As regards lipids, we only observed a significant decrease in triglycerides after 18 months of LMWH treatment. Conclusions: Routine use of LMWH during hemodialysis affords a safe and effective alternative to SH, and causes reduced platelet activation.

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

“…Previous reports revealed that most bleeding events were minor and tended to occur at vascular access sites. 3,6,12 In our study, the incidence of bleeding and adverse events was 24.2% (15/62) in patients using nadroparin. These findings are higher than those of previous reports.…”

“…These figures are consistent with previous reports. 12,28,29 The dosage of enoxaparin was an average of 0.6 mg/kg/session or 3714.3 ± 1204.4 IU/session in our study. The results were similar to previous reports.…”

“…Previous reports revealed that the optimum nadroparin dosage was between 64 and 70 IU/kg or 4100 IU/session in HD patients. 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.…”

“…These findings are higher than those of previous reports. 6,12 The incidence of minor bleeding was 14.3% (2/14) in patients using enoxaparin. This value is between two previously reported values ranging from 0.4% to 33%.…”

“…Stefoni et al 12 reported that no bleeding episode was observed in patients using nadroparin. Nurmohamed et al 6 reported that 8.6% (3/35) of minor bleeding episodes were observed in patients who were subjected to procedures that involved nadroparin.…”