Comparison of Unfractionated Heparin and Low Molecular Weight Heparin during Long-Term Use in Chronic Haemodialysis and Haemofiltration Patients

Abstract

Antithrombotic activity, necessary doses and effects on coagulation and lipid variables of the low molecular weight heparin derivative Fragmin were compared to unfractionated (UF) heparin in long-term multicentre trials. Results of more than 10,000 dialyses are reported. On the basis of preliminary studies, UF heparin and Fragmin doses were used that lead to anti-Xa activities of more than 0.5 U/ml. With this dose, sufficient antithrombotic activity was achieved with both heparins. Bleeding complications were not noticed. Partial thromboplastin time (PTT) and thrombin time were only marginally increased by Fragmin (5–8 s) in contrast to UF heparin (PTT 90–120 s, thrombin time 230–260 s). Surprisingly, the elevated levels of factor VIII strongly decreased during the 6-month treatment period with Fragmin and increased again during the following 6-month treatment period with UF heparin. Creatinine, urea, haemoglobin and transaminases did not change in both heparin groups: this excluded reduced dialysis efficiency or occult blood loss. Additionally, 15 patients with acute renal failure and high bleeding risk were dialysed with low doses of Fragmin (anti-FXa: 0.2–0.3 U/ml). No severe bleeding occurred. A continuous ambulant peritoneal dialysis patient with deep vein thrombosis was treated effectively with intraperitoneal application of Fragmin for 6 months without any problems.

Anticoagulation with Low Molecular Weight Heparin (Fragmin) during Continuous Hemodialysis in the Intensive Care Unit

“…Anti-Xa activity was in the range 0.27-0.53 IU/ml. It has been recommended that activity should be in the range 0.2-0.4 IU/ml for standard intermittent hemodialysis in patients with acute renal failure at high risk of bleeding (9).…”

Safety and Efficacy of Low Molecular Weight Heparins for Hemodialysis in Patients with End-Stage Renal Failure

“…We excluded 114 studies after title and abstract screening using inclusion and exclusion criteria. Of the 33 remaining studies, 15 did not meet the inclusion criteria after article review: 14 studies were not randomized (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25), and one study used a historical control UFH arm (26). One study was excluded because all patients had underlying hypercoagulability (27).…”

Effects of Conventional Heparin and Low-Molecular-Weight Heparin Treatment on Lipid Metabolism during a Single Hemodialysis Session

“…Although standard heparin (H) is a reliable anticoagulant, there are some problems associated with its use during dialysis. Bleeding, thrombocytopenia, allergic reactions, hair loss, osteoporosis and interactions of lipid metabolism are the main problems [1,2].…”