Comparison of Tinzaparin™ and Unfractionated Heparin as Anticoagulation on Haemodialysis: Equal Safety, Efficacy and Economical Parity

Bramham, Kate; Varrier, Matthew; Asgari, Elham; Makanjuola, David

doi:10.1159/000158561

Cited by 23 publications

(33 citation statements)

References 64 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…They are administered as single bolus injection at the start of the HD session and hence, their use is less time-consuming. LMWHs are well-tolerated and efficacious for use in HD patients [4,5]. Set against these are reduced reversibility by protamine and the lack of a means for simple real-time monitoring of the anticoagulant effect.…”

Section: Introductionmentioning

confidence: 99%

Dalteparin Dosing in High-Flux Haemodialysis and Haemodiafiltration

et al. 2013

View full text Add to dashboard Cite

Background: Low-molecular-weight heparins are being increasingly used as an alternative to unfractionated heparin for anticoagulation of the haemodialysis (HD) circuit. Data on dalteparin use in high-flux HD and haemodiafiltration (HDF) are limited. We examined the safety and efficacy of dalteparin in this setting to enable recommendations on the optimal dose range. Methods: This prospective study was conducted in a single dialysis unit. Subjects who had been receiving dalteparin for at least 10 HD sessions were studied. Anti-Xa activity was measured for all subjects at the start of the HD session, at 60 min into HD and at the end of dialysis. Results: 55 subjects were studied. None had detectable anti-Xa activity at the start of the session. Using adequacy criteria based on target anti-Xa activity >0.4 IU/ml at 1 h and <0.4 IU/ml at the end of dialysis, 39 (71%) patients had adequate anticoagulation, 12 (22%) patients were under-anticoagulated and 4 (7%) were over-anticoagulated. The mean dose in the adequately anticoagulated group was 60.7 ± 11.7 IU/kg, in the under-anticoagulated group 39.3 ± 9.6 IU/kg and in the over-anticoagulated group 70.1 ± 14.6 IU/kg. The optimal dose of dalteparin appears to be 60 ± 10 IU/kg, which facilitates the achievement of the target anti-Xa activity in the range of 0.4-0.75 IU/ml at 1 h and <0.4 IU/ml at the session end. Conclusion: Dalteparin is a safe and effective anticoagulant for patients on high-flux HD and HDF. The optimal dose appears to be 60 ± 10 IU/kg. The desirable target range of anti-Xa activity is 0.4-0.75 at 1 h and <0.4 IU/ml at the session end.

show abstract

Section: Introductionmentioning

confidence: 99%

Dalteparin Dosing in High-Flux Haemodialysis and Haemodiafiltration

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Clinically in small trials and in a 2004 meta-analysis, LMWH has been shown to be effective and safe [4]. Whether any LMWH is superior to another, and how they should be used and monitored on HD, remains less clear.…”

Section: Introductionmentioning

confidence: 99%

Anti-Xa Activity Supports Using a Simple Dosing Algorithm for Tinzaparin for Anticoagulation in Hemodialysis

et al. 2013

View full text Add to dashboard Cite

Background: Unfractionated heparin has been traditionally used for anticoagulation during hemodialysis (HD), but more recently low-molecular-weight heparin (LMWH) is being used as an alternative. Anti-Xa activity can be measured as a surrogate of LMWH efficacy. We present 52 patients treated with tinzaparin anticoagulation on HD, confirming that fixed dosing is safe and efficacious with sound pharmacodynamic reason in relation to anti-Xa profiling. Methods: We undertook a prospective audit in a single dialysis unit. All patients were established on a simple anticoagulation protocol for at least 1 month prior to the audit. Blood anti-Xa activity was measured at time 0, 30, 60 and 120 min into and at the end of HD. Efficacy and safety data were collected on the study day and the two sessions before and after it. Results: Fifty-two patients were included in the efficacy and safety analysis with 43 patients undergoing anti-Xa analysis (9 sampling errors). Using current consensus (an end-HD anti-Xa activity of <0.4 IU/ml), our fixed-dose protocol resulted in satisfactory safety in all patients tested. Of 260 HD sessions, 10 (4%) had reduced tinzaparin efficacy. During 105 dialysis sessions (21 patients) using an arteriovenous fistula, 4 patients had one episode of minor bleeding and there were 6 episodes (2 patients) of post-needle-compression time greater than 15 min. Conclusion: Tinzaparin administered thrice weekly as a fixed dose has good efficacy and is well tolerated as an anticoagulant during HD when used according to our protocol.

show abstract

“…The inter-rater agreement was excellent with a weighted kappa of 0.94 for study selection. In the meta-analysis, we included nine studies [13–15, 22–24, 26–28] that recorded bleeding episodes and 11 studies [13, 17–21, 23, 24, 26–28] evaluating lipid changes. Of note, when a study evaluated the same outcome within two different groups of patients and different settings we considered each part of the article as an independent study for both the systematic review and the meta-analysis [17, 28].…”

Section: Resultsmentioning

confidence: 99%

“…All the non-English articles were translated but did not meet criteria. Five studies were with a randomized cross-over design [16, 22, 24, 27, 29], nine were non-randomized cross-over [13–15, 17, 19–21, 25, 28] and three parallel design with randomization [18, 23, 26]. Two studies were excluded from the review since they reported the same results as studies included in the present review.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Safety of low-molecular-weight heparin compared to unfractionated heparin in hemodialysis: a systematic review and meta-analysis

et al. 2017

View full text Add to dashboard Cite

BackgroundLow molecular weight heparins (LMWH) have been extensively studied and became the treatment of choice for several indications including pulmonary embolism. While their efficacy in hemodialysis is considered similar to unfractionated heparin (UFH), their safety remains controversial mainly due to a risk of bioaccumulation in patients with renal impairment. The aim of this systematic review was to evaluate the safety of LMWH when compared to UFH for extracorporeal circuit (ECC) anticoagulation.MethodsWe used Pubmed, Embase, Cochrane central register of controlled trials, Trip database and NICE to retrieve relevant studies with no language restriction. We looked for controlled experimental trials comparing LMWH to UFH for ECC anticoagulation among end-stage renal disease patients undergoing chronic hemodialysis. Studies were kept if they reported at least one of the following outcomes: bleeding, lipid profile, cardiovascular events, osteoporosis or heparin-induced thrombocytopenia. Two independent reviewers conducted studies selection, quality assessment and data extraction with discrepancies solved by a third reviewer. Relative risk and 95% CI was calculated for dichotomous outcomes and mean weighted difference (MWD) with 95% CI was used to pool continuous variables.ResultsSeventeen studies were selected as part of the systematic. The relative risk for total bleeding was 0.76 (95% CI 0.26–2.22). The WMD calculated for total cholesterol was −28.70 mg/dl (95% CI -51.43 to −5.98), a WMD for triglycerides of −55.57 mg/dl (95% CI -94.49 to −16.66) was estimated, and finally LDL-cholesterol had a WMD of −14.88 mg/dl (95% CI -36.27 to 6.51).ConclusionsLMWH showed to be at least as safe as UFH for ECC anticoagulation in chronic hemodialysis. The limited number of studies reporting on osteoporosis and HIT does not allow any conclusion for these outcomes. Larger studies are needed to evaluate properly the safety of LMWH in chronic hemodialysis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-017-0596-4) contains supplementary material, which is available to authorized users.

show abstract

Comparison of Tinzaparin™ and Unfractionated Heparin as Anticoagulation on Haemodialysis: Equal Safety, Efficacy and Economical Parity

Cited by 23 publications

References 64 publications

Dalteparin Dosing in High-Flux Haemodialysis and Haemodiafiltration

Dalteparin Dosing in High-Flux Haemodialysis and Haemodiafiltration

Anti-Xa Activity Supports Using a Simple Dosing Algorithm for Tinzaparin for Anticoagulation in Hemodialysis

Safety of low-molecular-weight heparin compared to unfractionated heparin in hemodialysis: a systematic review and meta-analysis

Contact Info

Product

Resources

About