Low Molecular Weight Heparin (CY-216) versus Unfractionated Heparin in Chronic Hemodialysis

Abstract

In 14 patients undergoing chronic hemodialysis, we investigated the safety and efficacy of the low molecular fragment (CY-216) in comparison to unfractionated heparin (UFH) in the prevention of clotting in the extracorporeal circuit (ECC). In this study, 168 hemodialysis sessions were undertaken with UFH in 2 bolus doses (5,437 ± 1,477 SD IU) and 231 with CY-216 in a single bolus dose [initial dose 150 anti-Xa U Institut Choay (IC)/kg]. There were no clots in the bubble trap in any UFH sessions, and 14.8% had coagulated fibers in the dialyzer. Clotting in the bubble trap was observed in 2 CY-216 sessions (0.8%) and coagulated fibers in 22.6% of the sessions. At the end of the study, the mean dose of CY-216 was 250 anti-Xa UlC/kg but a dose of 350 anti-Xa UlC/kg was needed in the 2 patients treated by recombinant human erythropoietin. Anti-Xa levels at the end of the runs were higher (0.47 ± 0.1 U/ml) in the CY-216 group than in the UFH group (0.28 ± 0.1 U/ml). There was a correlation between anti-Xa levels and efficacy in the CY-216 group. An anti-Xa activity above 0.4 U/ml was needed in order to minimize thrombus formation. Antithrombin III-protease complexes (ATM) and D dimer fibrin derivatives (D dimer) were used as thrombotic markers but they were of little value for the detection of fibrin formation in the ECC. Our findings suggest that CY-216 administered as a single bolus dose seems to be of similar effectiveness to UFH.

Pharmacokinetics of Dalteparin during Haemodialysis

“…In other studies different recommendations of the C last after 4 h of haemodialysis are suggested to minimize clot formation, ranging from 0.15 IU/ml [12] to an anti-Xa activity above 0.40 IU/ml [9,13]. In our study, the mean C last was 0.15 IU/ml in group 1 and 0.60 IU/ml in group 2.…”

Dalteparin Dosing in High-Flux Haemodialysis and Haemodiafiltration

“…Dalteparin, as a single bolus injection, has been shown to prevent extracorporeal circuit clotting during HD [5,7]. Anti-Xa activity can be used to assess dose requirements, but there is considerable debate on the target end-dialysis anti-Xa activity with some suggesting a target of >0.4 IU/ml [5,8,9] and others <0.4 IU/ml [7]. Much of the literature on LMWH use in HD reports efficacy and safety data as assessed clinically by extracorporeal circuit clotting and bleeding complications.…”

Treatment of Pulmonary Embolism by Subcutaneous Low-Molecular- Weight Heparin in a Hemodialysis Patient

“…This dosage was significantly lower than the usually recommended dose of 250 IC AXaU/kg [18]. However, the anti-Xa activity throughout the hemodialysis session was maintained above the recommended level of 0.4 U/ ml which is required for adequate anticoagulation [18].…”

“…In our case, neither thrombolytic agent nor oral anticoagulant was considered because of the risk of excessive bleeding and the need for prolonged compression of the needle puncture site. LMWH has been generally accepted as an alternative to heparin in the prevention of clotting in extracorporeal circuit in chronic hemodialysis patients [18][19][20]. LMWH was used instead of UFH as there is evidence that the risk of bleeding with LMWH therapy is less and it can avoid prolonged compression time of the puncture site [21].…”