The rationale for the use of low molecular weight heparin for hemodialysis treatments

Davenport, Andrew

doi:10.1111/hdi.12086

Cited by 15 publications

(21 citation statements)

References 20 publications

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“…Also, anticoagulants are used during dialysis to prevent thrombosis in the HD circuit. LMWH has now replaced the use of unfractionated heparin (UHF) and is associated with fewer bleeding episodes and a reduced incidence of heparin-induced thrombocytopenia, compared with UFH [ 24 , 25 ]. In this case, we selected the use of NM as the anticoagulant used during dialysis, immediately following the resolution of the episode of SSEH, because NM is characterized by a short half-life.…”

Section: Discussionmentioning

confidence: 99%

Successful Recovery from Spontaneous Spinal Epidural Hematoma in a Patient Undergoing Hemodialysis

et al. 2017

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Patient: Male, 70Final Diagnosis: Spontaneous spinal epidural hematomaSymptoms: Abdominal pain • chest pain • complete paraplegiaMedication: —Clinical Procedure: Conservative managementSpecialty: NephrologyObjective:Unusual clinical courseBackground:Spontaneous spinal epidural hematoma (SSEH) occurs in the spinal epidural space in the absence of traumatic or iatrogenic causes, and is considered to be a neurological emergency, as spinal cord compression may lead to neurological deficit. Prompt diagnosis of SSEH can be difficult due to the variety of presenting symptoms, which may resemble those of stroke. Patients who undergo hemodialysis (HD) are at risk of bleeding due to anticoagulation during dialysis and uremia. However, SSEH in HD patients undergoing HD has rarely been reported.Case Report:A 70-year-old Japanese man, who has been undergoing maintenance HD for the previous three years, was admitted to Kariya Toyota General Hospital, Aichi, Japan, with acute chest and abdominal pain, and with complete paraplegia. The patient denied any recent trauma or medical procedures. Magnetic resonance imaging showed an extensive hematoma in the thoracic and lumbar epidural space, extending from T8 to L5. The patient’s symptoms improved within three hours following hospital admission, and after three days without HD treatment, the SSEH decreased in size, and the patient successfully recovered without residual neurological deficits and without requiring surgery.Conclusions:The management of SSEH in patients undergoing HD can be difficult, due to anticoagulation during dialysis and uremia. Prompt diagnosis and close neurological monitoring are important for appropriate management. In patients whose symptoms improve within a short period, conservative management may be considered.

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Section: Discussionmentioning

confidence: 99%

Successful Recovery from Spontaneous Spinal Epidural Hematoma in a Patient Undergoing Hemodialysis

et al. 2017

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“…Although LMWHs have become the anticoagulation of choice for intermittent hemodialysis sessions in Europe [ 27 ], their use for interdialytic catheter locking has been scarcely reported [ 28 ], [ 29 ]. To the best of our knowledge, the compatibility of LMWHs/ethanol mixing solutions has not been previously documented.…”

Section: Discussionmentioning

confidence: 99%

“…UFH is a heterogeneous mixture of polysaccharides with variable molecular weight and whether ethanol causes precipitation of fractionated heparin, pentasaccharide Factor Xa inhibitor, and heparinoids remains unknown. These treatments are increasingly used for anticoagulation during dialysis sessions [ 7 , 27 , 28 ] and could be an appropriate alternative for inter-dialytic lock solutions [ 29 ]. The aim of the study was to assess the compatibility of IAAs in ethanol and to determine the anti-biofilm activity of the optimal combination against several microorganisms commonly involved in catheter-related infections and its effect on the integrity of polyurethane DCs.…”

Section: Introductionmentioning

confidence: 99%

Compatibility of Injectable Anticoagulant Agents in Ethanol; In Vitro Antibiofilm Activity and Impact on Polyurethane Catheters of Enoxaparin 400 U/mL in 40% v/v Ethanol

Balestrino¹,

Quintana²,

Charbonnel³

et al. 2016

PLoS ONE

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Background and ObjectivesInterdialytic lock solutions should maintain catheter patency and prevent catheter infections. We aimed to determine in which conditions injectable anticoagulant agents (IAAs) combined with ethanol are compatible and to assess the antibiofilm activity of the selected combination and its effects on dialysis catheters (DC).MethodsThe solubility and compatibility of unfractionated heparin (UFH), low molecular weight heparins (LMWHs), heparinoids and fondaparinux (50 to 2,500 U/mL) in 30 to 70% ethanol were determined by visual observation. The stability of enoxaparin in ethanol and the ethanol content were assessed by high performance liquid chromatography (HPLC) and titrimetric control, respectively. The bactericidal effect was determined on 24h-old biofilms embedded in silicone-DC. The integrity of polyurethane-DC immersed in anticoagulant-ethanol was assessed by gas chromatography-mass spectrometry (GC-MS) and compared with previously published results.ResultsThe compatibility of IAAs and ethanol varied according to IAA type and concentration, and ethanol content. UFH in 40% ethanol was not compatible, whatever the UFH concentration used. Established limits of compatibility of enoxaparin, nadroparin, dalteparin and tinzaparin in 40% ethanol were 1350, 575, 307 and 207 U/ml, respectively, and up to 300 U/ml for danaparoid and 1 mg/mL for fondaparinux. Enoxaparin 400 U/mL in 40% ethanol (Enox/Eth) eradicated biofilm after 4 hours of exposure for Staphylococcus epidermidis, Pseudomonas aeruginosa and Candida albicans and after 24 hours for Klebsiella pneumoniae and S. aureus. Aliphatic carbonate and alcohol compounds were released by polyurethane-DC after Enox/Eth exposure, as after 40% ethanol or saline exposure. There was no significant difference between the amounts released after 30 minutes of exposure to Enox/Eth and 15 days to saline.ConclusionsA 40% ethanol solution can be combined with all IAAs but UFH. Enox/Eth was effective as an anti-biofilm agent with minor impacts on DC integrity and could be a useful interdialytic lock solution.

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“… 1 , 2 Not only does LMWH have a predictive dose-response relationship, but it also does not need monitoring and is easy to administer and is therefore attractive to health practitioners and nurses. 3 LMWH started to replace UFH in hemodialysis for the extracorporeal circuit anticoagulation especially in western Europe 4 , 5 with the recommendations published in the European Best Practice Guidelines by the European Renal Association—European Dialysis and Transplant Association (ERA-EDTA). 6 However the transition toward LMWH in hemodialysis was controversial.…”

Section: Introductionmentioning

confidence: 99%

Association Between Low-Molecular-Weight Heparin and Risk of Bleeding Among Hemodialysis Patients: A Retrospective Cohort Study

Lazrak

René

Elftouh

et al. 2018

Can J Kidney Health Dis

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Background:Low-molecular-weight heparins (LMWH) replaced unfractionated heparin (UFH) in multiple indications. Although LMWH efficacy in hemodialysis was demonstrated through multiple studies, their safety remains controversial. The potential bioaccumulation in patients undergoing chronic hemodialysis raised the question of bleeding risk among this population.Objective:The aim of this study was to evaluate bleeding risk among patients with chronic hemodialysis receiving LMWH or UFH for the extracorporeal circuit anticoagulation.Design:We conducted a retrospective cohort study on data extracted from the Régie de l’assurance maladie du Québec (RAMQ) and Med-Echo databases from January 2007 to March 2013.Setting:Twenty-one hemodialysis centers in the province of Québec, Canada.Patients:Chronic hemodialysis patients.Measurements:Bleeding risk evaluated by proportional Cox model for time-dependent exposure using demographics, comorbidities, and drug use as covariates.Methods:Minor, major, and total bleeding events identified using International Classification of Diseases, Ninth Revision (ICD-9)/International Classification of Diseases, Tenth Revision (ICD-10) codes in the RAMQ and Med-Echo databases. Exposure status to LMWH or UFH was collected through surveys at the facility level.Results:We identified 5322 prevalent and incident patients with chronic hemodialysis. The incidence rate for minor, major, and total bleeding was 9.45 events/1000 patient-year (95% confidence interval [CI]: 7.61-11.03), 24.18 events/1000 patient-year (95% CI: 21.52-27.08), and 32.88 events/1000 patient-year (95% CI: 29.75-36.26), respectively. We found similar risks of minor adjusted hazard ratio (HR: 1.04; 95% CI: 0.68-1.61), major (HR: 0.83; 95% CI: 0.63-1.10), and total bleeding (HR: 0.90; 95% CI: 0.72-1.14) when comparing LMWH with UFH.Limitations:Potential misclassification of patients’ exposure status and possible underestimation of minor bleeding risk.Conclusion:LMWH was not associated with a higher minor, major, or total bleeding risk. LMWH did not increase the risk of bleeding compared with UFH for the extracorporeal circuit anticoagulation in hemodialysis. The convenience of use and predictable effect made LMWH a suitable alternative to UFH in hemodialysis.

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The rationale for the use of low molecular weight heparin for hemodialysis treatments

Cited by 15 publications

References 20 publications

Successful Recovery from Spontaneous Spinal Epidural Hematoma in a Patient Undergoing Hemodialysis

Successful Recovery from Spontaneous Spinal Epidural Hematoma in a Patient Undergoing Hemodialysis

Compatibility of Injectable Anticoagulant Agents in Ethanol; In Vitro Antibiofilm Activity and Impact on Polyurethane Catheters of Enoxaparin 400 U/mL in 40% v/v Ethanol

Association Between Low-Molecular-Weight Heparin and Risk of Bleeding Among Hemodialysis Patients: A Retrospective Cohort Study

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