A review of 122 published outcomes of danaparoid anticoagulation for intermittent haemodialysis

Magnani, H.N.

doi:10.1016/j.thromres.2009.10.008

Cited by 21 publications

(18 citation statements)

References 43 publications

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“…153 In the review, thrombosis of either the patient or the hemodialysis circuit occurred in 7% of the 97 patients with HIT, and major bleeding occurred in 6%. 153 Only one-third of the patients in this study had the diagnosis of HIT confi rmed with a functional assay. Small RCTs that compared danaparoid with heparin or LMWH during hemodialysis in patients without HIT have also shown it to be effective and safe.…”

Section: Lepirudin (Recombinant Hirudin)mentioning

confidence: 98%

Treatment and Prevention of Heparin-Induced Thrombocytopenia

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Moores

et al. 2012

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335

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Section: Lepirudin (Recombinant Hirudin)mentioning

confidence: 98%

Treatment and Prevention of Heparin-Induced Thrombocytopenia

Linkins

Dans

Moores

et al. 2012

Chest

855

335

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“…Hemodialysis and other forms of renal replacement therapy have an important distinguishing feature from cardiac/ vascular surgery, namely that they are not a one-off exposure but rather a therapy that will require continuous or intermittent heparin exposure for a period of at least several days, if not weeks, months, or indefinitely. Thus, acute hemodialysis and other renal replacement therapy will generally require anticoagulation with a non-heparin anticoagulant (eg, argatroban, 51 danaparoid, 52 bivalirudin, 53 or fondaparinux [54][55][56] ), which at least in theory can be continued indefinitely. However, the expense and inconvenience of using an alternative non-heparin anticoagulant for intermittent hemodialysis 3 times per week on an indefinite basis has led some investigators [57][58][59] to resume UFH anticoagulation after HIT antibody seroreversion.…”

Section: Hemodialysismentioning

confidence: 99%

How I treat patients with a history of heparin-induced thrombocytopenia

Warkentin

Anderson

2016

Blood

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Heparin-induced thrombocytopenia (HIT) is a relatively common prothrombotic adverse drug reaction of unusual pathogenesis that features platelet-activating immunoglobulin G antibodies. The HIT immune response is remarkably transient, with heparin-dependent antibodies no longer detectable 40 to 100 days (median) after an episode of HIT, depending on the assay performed. Moreover, the minimum interval from an immunizing heparin exposure to the development of HIT is 5 days irrespective of the patient’s previous heparin exposure status or history of HIT. This means that short-term heparin reexposure can be safely performed if platelet-activating antibodies are no longer detectable at reexposure baseline and is recommended when heparin is the clear anticoagulant of choice, such as for cardiac or vascular surgery. The risk of recurrent HIT 1 to 2 weeks after heparin reexposure is ∼2% to 5% and is attributable to formation of delayed-onset (or autoimmune-like) HIT antibodies that activate platelets even in the absence of pharmacologic heparin. Some studies suggest that longer-term heparin reexposure (eg, for chronic hemodialysis) may also be reasonable. However, for other antithrombotic indications that involve patients with a history of HIT (eg, treatment of venous thromboembolism or acute coronary syndrome), preference should be given to non-heparin agents such as fondaparinux, danaparoid, argatroban, bivalirudin, or one of the new direct-acting oral anticoagulants as appropriate.

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“…A review of 122 patients who had a contraindication to heparin use found 14 nonfatal bleeding events and 8 instances of dialysis circuit clotting. 120 Danaparoid currently is not available in the United States. Concern that it has proven cross-reactivity with HIT antibodies in a small percentage of patients has slowed its adoption of use in other countries.…”

Section: Alternatives To Ufhmentioning

confidence: 99%

Use and Safety of Unfractionated Heparin for Anticoagulation During Maintenance Hemodialysis

Shen

Winkelmayer

2012

American Journal of Kidney Diseases

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Anticoagulation is essential to hemodialysis, and unfractionated heparin (UFH) is the most commonly used anticoagulant in the United States. However, there is no universally accepted standard for its administration in long-term hemodialysis. Dosage schedules vary and include weight-based protocols and low-dose protocols for those at high risk of bleeding, as well as regional anticoagulation with heparin and heparin-coated dialyzers. Adjustments are based largely on clinical signs of under- and overanticoagulation. Risks of UFH use include bleeding, heparin-induced thrombocytopenia, hypertriglyceridemia, anaphylaxis, and possibly bone mineral disease, hyperkalemia, and catheter-associated sepsis. Alternative anticoagulants include low-molecular-weight heparin, direct thrombin inhibitors, heparinoids, and citrate. Anticoagulant-free hemodialysis and peritoneal dialysis also are potential substitutes. However, some of these alternative treatments are not as available as or are more costly than UFH, are dependent on country and health care system, and present dosing challenges. When properly monitored, UFH is a relatively safe and economical choice for anticoagulation in long-term hemodialysis for most patients.

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A review of 122 published outcomes of danaparoid anticoagulation for intermittent haemodialysis

Cited by 21 publications

References 43 publications

Treatment and Prevention of Heparin-Induced Thrombocytopenia

Treatment and Prevention of Heparin-Induced Thrombocytopenia

How I treat patients with a history of heparin-induced thrombocytopenia

Use and Safety of Unfractionated Heparin for Anticoagulation During Maintenance Hemodialysis

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