Long-Term Use of the Low Molecular Weight Heparin Tinzaparin in Haemodialysis

Simpson, Hamish; Baird, J. D.; Allison, M. E. M.; Briggs, J. D.; Rowe, P. A.; Welsh, Maria; Macdougall, A.I.; Grant, A.L.; Lowe, G. D. O.; Rumley, A.; Wallace, M. Christopher; Menday, A. P.

doi:10.1159/000217193

Cited by 14 publications

(16 citation statements)

References 9 publications

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“…Our findings are in line with those obtained with tinzaparin [28]. The serum FPA concentration and the anti-FXa action follows an inverse trend.…”

Section: Discussionsupporting

confidence: 92%

“…Like previous reports [28, 29, 30, 31, 32, 33, 34]based on a short-term follow-up, our study confirms that adequate and safe anticoagulation levels may be achieved with LMWH during hemodialysis together with a low risk of bleeding. This was so whether we used a PS low-flux or PS high-flux membrane.…”

Section: Discussionsupporting

confidence: 90%

“…Simpson et al [28]have shown that no significant change in needle site bleeding time distinguishes tinzaparin from SH; Saltissi et al [32]confirm the finding in the case of enoxaparin. Our results actually show a significantly shorter bleeding time for nadroparin vs. SH.…”

Section: Discussionmentioning

confidence: 94%

“…Other low-molecular-weight heparins have shown a broad dose variability between individuals searching for effective intradialytic anticoagulation. This applies tinzaparin [28]and reviparin [29]. Interestingly, using nadroparin the membrane cut off does not exert any effect on the anti-FXa activity, so that nadroparin becomes equally anticoagulant in hemodialysis and in hemodiafiltration.…”

Section: Discussionmentioning

confidence: 99%

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Standard Heparin versus Low-Molecular-Weight Heparin

Stefoni¹,

Cianciolo²,

Donati³

et al. 2002

Nephron

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Background: To compare standard heparin (SH) and low molecular weight heparin (LMWH) in terms of anticoagulation, platelet activation and lipid metabolism, we selected 54 patients who had been on 4-hour hemodialysis three times weekly for at least 12 months, without bleeding disorders or dyslipidemic diseases. 28 were on hemodialysis with Polysulfone low-flux, 26 were on hemodiafiltration with Polysulfone high-flux. All patients underwent EPO. Methods: During the first 18 months, we administered SH 1,500 IU on starting dialysis and 1,500 ± 500 IU in continuous intradialytic infusion per session. In the following 18 months, we administered LMWH 64.6 IU/kg on starting dialysis in a single arterious bolus. We assessed aPTT, anti-factor Xa activity, TAT and FPA, β-TG and PF4. Blood samples were taken monthly at times 0, 30, 60, 180 and 240 min, as well as 1, 4 and 20 h after dialysis end. Predialysis cholesterol, HDL, LDL, triglycerides and lipoprotein(a) were checked monthly. Results: During both LMWH and SH sessions no clotting or major bleeding complications were observed. APTT with LMWH was lower than that found with SH (p < 0.001); aFXa using LMWH was higher than when using SH (p < 0.001); TAT and FPA were lower in LMWH sessions (p < 0.01) than in SH sessions. We also detected lower β-TG (p < 0.05) and PF4 levels (p < 0.05) using LMWH than using SH. As regards lipids, we only observed a significant decrease in triglycerides after 18 months of LMWH treatment. Conclusions: Routine use of LMWH during hemodialysis affords a safe and effective alternative to SH, and causes reduced platelet activation.

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“…Our findings are in line with those obtained with tinzaparin [28]. The serum FPA concentration and the anti-FXa action follows an inverse trend.…”

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Standard Heparin versus Low-Molecular-Weight Heparin

Stefoni¹,

Cianciolo²,

Donati³

et al. 2002

Nephron

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show abstract

“…We also showed that the changes of APTT and plasma antithrombin activity were not sensitive enough for monitoring serum LMWH activity. These results are comparable with those obtained in previous studies with higher LMWH dosages [4, 5]. …”

Section: Discussionsupporting

confidence: 92%

Low Molecular Weight Heparin in Hemodialysis Patients with a Bleeding Tendency

Leu

Chiang²,

Lin

et al. 2000

Nephron

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Efficacy and safety of a low-molecular-weight heparin (LMWH) were studied in 33 stable maintenance hemodialysis patients who had a bleeding tendency on unfractionated heparin. The optimal dose of LMWH for each patient was titrated before the study; the mean total LMWH dosage was 1,152 ± 574 IU. No major bleeding or clot formation was noted in a total of 2,470 hemodialysis sessions during 6 months of LMWH administration. The mean value of plasma anti-factor Xa (anti-Xa) activity increased from 0.05 ± 0.03 IU/ml before dialysis to 0.34 ± 0.28 IU/ml after 2 h of dialysis and returned to 0.15 ± 0.09 IU/ml after 4 h of dialysis; the mean activated partial thromboplastin time was 26.1 ± 4.4 s before dialysis, 30.7 ± 9.5 s (an 18% increase) after 2 h of dialysis, and 26.2 ± 4.4 s after 4 h of dialysis. No significant change in serum antithrombin levels was noted throughout the whole study period. We conclude that a low dosage of LMWH is safe and effective in hemodialysis patients who have a risk of bleeding with unfractionated heparin. Serum anti-Xa activity is better than activated partial thromboplastin time and antithrombin in assessing the optimal dose of LMWH. A plasma anti-Xa activity of 0.37 IU/ml after 2 h of hemodialysis may represent an optimal dosage of LMWH for most patients.

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Dose Titration Study of Tinzaparin, a Low Molecular Weight Heparin, in Patients on Chronic Hemodialysis

et al. 1998

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The minimal necessary dose of Innohep (IH) (MNDI) (Innohep [tinzaparin], Leo Pharmaceutical Corp., Ballerup, Denmark) was examined in 40 patients switched from conventional heparin ([CH], Leo Pharmaceutical Corp.) to IH and in 13 patients already treated with IH. Clotting in the venous chamber and in the dialyzer was evaluated on a 4 point scale by visual inspection. IH was administrated as a bolus injection into the arterial side of the dialyzer at the beginning of dialysis sessions. The initial dose of IH was 50% of the total dose of CH used before the study (in respective IU). According to clotting in the venous chamber or dialyzer, the dose of IH was titrated by stepwise changes of 500 IU to the lowest possible dose until 3 subsequent dialysis sessions without clotting were obtained. The total dose of CH (bolus and infusion) before switching was 6,162 +/- 2,100 IU. The bleeding time from the cannulation site after dialysis, in 24 patients with A-V fistulas, was 7.1 +/- 2.8 min(triplicates). Eight patients were excluded before achieving the MNDI, 3 due to bleeding not clearly related to heparinization (1 due to gingival bleeding, 1 to epistaxis, and 1 to sugillations), 1 due to alopecia, 2 due to a need of more than 10,000 IU of IH, and 2 patients due to cessation of treatment resulting from anxiety. After switching over, the MNDI amounted to 66 +/- 26% in respective IU. The conversion IH/CH ratio correlated significantly to the blood flow rate and the type of dialyzer. When compared on 3 subsequent sessions before and after switching to IH, no differences were found in the bleeding time after decannulation and in clotting in the venous chamber while dialyzer clotting fell on the visual scale from an average of 0.36 to 0.19 (p < 0.01). No total clot formation was observed during the study. The MNDI correlated positively to the body weight, blood flow rate, and time on dialysis (with the respective coefficients of correlation of r being 0.58, 0.44, and 0.30, p < 0.05) and was also influenced by the type of dialyzer. The average MNDIs for the Hemoflow-FS hollow-fiber (Fresenius, Bad Homburg, Germany), Lundia PRO plate (Gambro, Lund, Sweden), and Polyflux hollow fiber (Gambro) were 2,571, 3,727, and 5,020 IU (p < 0.01, ANOVA). In patients on chronic hemodialysis, IH given as a bolus of 4,250 IU effectively prevented extracorporeal clotting during dialysis, similarly to CH. However, a considerable individual variation in MNDIs not related to the need for CH was observed, and this necessitates individual dosage adjustments to obtain the optimal prevention of clotting with minimal bleeding risk.

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Long-Term Use of the Low Molecular Weight Heparin Tinzaparin in Haemodialysis

Cited by 14 publications

References 9 publications

Standard Heparin versus Low-Molecular-Weight Heparin

Standard Heparin versus Low-Molecular-Weight Heparin

Low Molecular Weight Heparin in Hemodialysis Patients with a Bleeding Tendency

Dose Titration Study of Tinzaparin, a Low Molecular Weight Heparin, in Patients on Chronic Hemodialysis

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