Clinical study on low‐molecular weight heparin infusion as anticoagulation for nocturnal home haemodialysis

Abstract

Low-molecular weight heparin infusion is practical and effective as anticoagulation for NHHD. It can be safely used in an alternate-day haemodialysis schedule. A close monitoring for LMWH accumulation is recommended if long dialysis is performed daily.

Correlation between activated partial thromboplastin time and anti‐Xa activity in patients who received low‐molecular weight heparin as anticoagulation for haemodialysis

“…The anticoagulation performance of this regimen was first compared to that of the single‐bolus injection of nadroparin in 4‐h haemodialysis treatments . Then the performance of this regimen was compared to that of UFH infusion in extended 8‐h haemodialyses . In both of these trials, serial blood samplings for paired APTT and anti‐Xa activity at scheduled intervals after nadroparin administration were performed.…”

“…2 Then the performance of this regimen was compared to that of UFH infusion in extended 8-h haemodialyses. 3 In both of these trials, serial blood samplings for paired APTT and anti-Xa activity at scheduled intervals after nadroparin administration were performed. Both trials were approved by the institutional ethics committee and written informed consents were obtained from the participants.…”

“…In our clinical trials that investigated the feasibility and safety of a LMWH infusion regimen as anticoagulation for haemodialysis, monitoring of plasma anti‐Xa activity and activated partial thromboplastin time (APTT) were performed. While anti‐Xa activity was elevated after LMWH administration, an associated prolongation in APTT was also evident.…”

Clinical practice guidelines for the provision of renal service in Hong Kong: Haemodialysis

“…A loading dose followed by a continuous infusion throughout the HD treatment is preferred as repeated intermittent dosing is usually not practical, particularly for nocturnal dialysis. Study on use of continuous infusion of LMWH in home HD has also been published …”

“…Study on use of continuous infusion of LMWH in home HD has also been published. 140 Mass balance studies in patients having long-hour dialysis found that the use of a dialysate calcium level of 1.25 mmol/L associates with a fall in pre-dialysis calcium level as well as increases in alkaline phosphatase and intact parathyroid hormone levels. Such abnormalities could be reversed by increasing the dialysate calcium level and hence, a dialysate calcium level of 1.5 mmol/L is suggested.…”