Controlled Study of Heparin versus Epoprostenol Sodium (Prostacyclin) as the Sole Anticoagulant for Chronic Hemodialysis

Caruana, Ralph J.; Smith, Michael C.; Clyne, David H.; Crow, James W.; Zinn, Jacqueline M.; Diehl, J.

doi:10.1159/000170027

Cited by 23 publications

(5 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In these challenging cases, a variety of methods have been proposed 7 . Regional heparin/protamine [8], regional citrate/calcium [9]–[13] and prostacyclin [14], [15] are efficient but their use was limited by technical difficulties or clinical complications. Conversely, intermittent saline flushes (ISS) and constant saline infusion (CSI) of the circuit were described as simple and safe techniques to reduce clotting [7], [16], [17] and are widely used use in daily practice.…”

Section: Introductionmentioning

confidence: 99%

Hemodialysis without Systemic Anticoagulation: A Prospective Randomized Trial to Evaluate 3 Strategies in Patients at Risk of Bleeding

et al. 2014

View full text Add to dashboard Cite

ObjectiveIn this clinical trial, we aimed to compare three means of performing chronic hemodialysis in patients with contra-indication to systemic heparinization.MethodsThis open-label monocentric randomized « n-of-one » trial, conducted in a single tertiary care center, recruited chronic hemodialysis patients with a contra-indication to systemic heparinization for at least 3 consecutive sessions. All patients underwent hemodialysis with an AN69ST dialyzer, and were administered three alternative dialysis procedures in a random sequence: intermittent saline flushes, constant saline infusion, or pre-dialysis heparin coating of the membrane. The primary outcome was the need to interrupt the dialysis session because of clotting events due to either (i) a complete coagulation of the circuit; (ii) a partial coagulation of the circuit; (iii) a>50% rise over baseline in the venous pressure.ResultsAt the end of the inclusion period (May, 2007 to December, 2008), the number of patients to include (n = 75) was not reached: only 46 patients were included and underwent randomization. The study was terminated, and statistical analysis took into account 224 hemodialysis sessions performed in 44 patients with analyzable data. Heparin adsorption was associated with a significant reduction of the need to interrupt the dialysis session because of clotting events: odds ratio 0.3 (CI 95% 0.2 to 0.6; p<0.001, versus intermittent saline flushes). Heparin adsorption was also associated with higher odds for performing >3 h dialysis sessions and for having complete blood restitution. There were no significant effects of the dialysis procedure on weight loss, online ionic dialysance, and adverse events.ConclusionHeparin-coated AN69ST dialysis membrane is a safe and effective method to avoid or delay per-dialytic clotting events in patients with contra-indication to systemic anticoagulation. However, results are not generalizable safely to patients with active bleeding, since weak heparinemia, not assessed in this study, may occur.Trial RegistrationClinicalTrials.gov NCT00473109.

show abstract

Section: Introductionmentioning

confidence: 99%

Hemodialysis without Systemic Anticoagulation: A Prospective Randomized Trial to Evaluate 3 Strategies in Patients at Risk of Bleeding

et al. 2014

View full text Add to dashboard Cite

show abstract

“…This avoids the risk of citrate overload and enables this procedure to be used even in patients with liver failure. The success rate of this dialysis procedure is similar to conventional RCA with a calcium‐free dialysate 28 and better than other heparin‐free techniques, such as regular saline flushes 30 or the use of prostacyclin 31 or heparin‐coated polyacrylonitrile membrane 26 …”

Section: Toward Heparin‐ and Acid‐free Routine Hemodialysismentioning

confidence: 85%

Can regional anticoagulation with calcium‐free dialysate be extended to maintenance hemodialysis?

Petitclerc,

Béné

2024

Artificial Organs

View full text Add to dashboard Cite

BackgroundRegional anticoagulation in hemodialysis avoids the use of heparin, which is responsible for both hemorrhagic and non‐hemorrhagic complications. Typically, blood is decalcified by injecting citrate into the arterial line of the extracorporeal circuit. Calcium‐free dialysate improves anticoagulation efficacy but requires injection of a calcium‐containing solution into the venous line and strict monitoring of blood calcium levels. Recent improvements have made regional anticoagulation with calcium‐free dialysate safer and easier.Observations(1) Adjusting the calcium injection rate to ionic dialysance avoids the risk of dyscalcemia, thus making unnecessary the monitoring of blood calcium levels. This adjustment could be carried out automatically by the hemodialysis monitor. (2) As calcium‐free dialysate reduces the amount of citrate required, this can be supplied by dialysate obtained from currently available concentrates containing citric acid. This avoids the need for citrate injection and the risk of citrate overload. (3) Calcium‐free dialysate no longer needs the dialysate acidification required for avoiding calcium carbonate precipitation in bicarbonate‐containing dialysate.ConclusionsRegional anticoagulation with calcium‐free dialysate enables an acid‐ and heparin‐free procedure that is more biocompatible and environmentally friendly than conventional bicarbonate hemodialysis. The availability of specific acid‐free concentrates and adapted hemodialysis monitors is required to extend this procedure to maintenance hemodialysis.

show abstract

“…Thus, we have only the option of either using isotonic or hypotonic citrate solutions in patients with HIT. More recently, prostacyclins have been studied as an alternative local anticoagulatory agent during hemodialysis [25]. Preliminary results suggest that they may be used safely without the metabolic complications associated with citrate.…”

Section: Local Anticoagulation Methodsmentioning

confidence: 99%

A Case Review: Anticoagulation in Hemodialysis Patients with Heparin-Induced Thrombocytopenia

Chuang¹,

Parikh

Reilly

2001

Am J Nephrol

View full text Add to dashboard Cite

We describe a patient with acute renal failure who subsequently developed heparin-induced thrombocytopenia (HIT) while on hemodialysis. Heparin was immediately discontinued and alternative modes of anticoagulation were considered as further hemodialysis was indicated. With several options available, a review of the current literature was performed to aid in the selection of the most appropriate method. We conclude that there is currently no ideal hemodialysis anticoagulation agent for a patient with HIT. Among the currently available alternatives, no anticoagulation or regional citrate infusion during hemodialysis appears to be the most reliable and safest option for these patients. Based upon its safety, reversibility, low cost and availability, a trial of warfarin also may be attempted for hemodialysis anticoagulation. Both danapranoid and lepirudin have been used effectively in hemodialysis patients with HIT, but have the disadvantage of prolonged half-lives in patients with renal failure and relatively high cost.

show abstract

Controlled Study of Heparin versus Epoprostenol Sodium (Prostacyclin) as the Sole Anticoagulant for Chronic Hemodialysis

Cited by 23 publications

References 7 publications

Hemodialysis without Systemic Anticoagulation: A Prospective Randomized Trial to Evaluate 3 Strategies in Patients at Risk of Bleeding

Hemodialysis without Systemic Anticoagulation: A Prospective Randomized Trial to Evaluate 3 Strategies in Patients at Risk of Bleeding

Can regional anticoagulation with calcium‐free dialysate be extended to maintenance hemodialysis?

A Case Review: Anticoagulation in Hemodialysis Patients with Heparin-Induced Thrombocytopenia

Contact Info

Product

Resources

About