Low molecular weight heparin in hemodialysis and hemofiltration patients

Schrader, J; Valentin, Rainer; Tönnis, H. J.; Hildebrand, U.; Stibbe, Werner; Armstrong, Victor W.; Kandt, M; Köstering, H.; Quellhorst, E

doi:10.1038/ki.1985.204

Cited by 58 publications

(18 citation statements)

References 27 publications

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“…In view of the results reported by other authors using LMWH in hemodialysis, the advantage of Fraxiparin is its use as a single intravenous bolus injection at the start of the session whereas an additional continuous in fusion is usually recommended with UFH [3,16,[20][21][22][23]. This is due to a greater half-life of Fraxiparin as compared to standard heparin.…”

Section: Discussionmentioning

confidence: 82%

Low-Molecular-Weight Heparin Fraxiparin® in Chronic Hemodialysis

Morinière

Dieval²,

Bayrou³

et al. 1989

Blood Purif

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A two-step dose-ranging study was undertaken with CY216 (Fraxiparin®) in 8 patients on 7 sessions each. The different doses were administered each time as a single bolus injection at the start of hemodialysis without heparinized priming nor further administration during the 4-hour session. In the first step, the clinical efficacy of 4 different doses of Fraxiparin was compared with that of standard heparin on the percentage of sessions free of clot formation in the extracorporeal circulation (ECC). Safety was evaluated by the compression time for hemostasis at the puncture sites. The second step was a randomized comparison of 3 Fraxiparin dosages. In addition to the clinical assessment of efficacy, the following biological parameters were measured: fibrinopeptide A (FPA), anti-Xa (AXa) activity calibrated against Fraxiparin, thrombin time (TT), activated partial thromboplastin time, blood counts, hemoglobin, hematocrit, plasma creatinine and urea, and residual blood volume in the dialyzer. A ‘standard’ dosage of 10,000 AXa Institut Choay units of Fraxiparin was shown to prevent clot formation in the ECC. It resulted in a marked increase in TT, without any lengthening of the puncture site compression time. After 4 h, AXa and FPA levels in the venous line were related to the doses used (p < 0.05). After 48 h AXa activity was very low. Dialysance and tolerance were excellent. Thus, a single dose of Fraxiparin unrelated to body weight and not determined by the measurement of the whole-blood activated clotting time appeared to be a safe and effective means for preventing fibrin formation in 4-hour dialysis sessions.

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Section: Discussionmentioning

confidence: 82%

Low-Molecular-Weight Heparin Fraxiparin® in Chronic Hemodialysis

Morinière

Dieval²,

Bayrou³

et al. 1989

Blood Purif

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“…However, in the former, the clotting episode tended to occur in low blood flow, hypo tension during dialysis and intradialytic blood transfusion [11,12]. Low-molecular-weight heparin has been reported to be a safe anticoagulant for these patients [13], but prolonga tion of the coagulation time could not be completely ruled out [14,15], and the half-life of low-molecular-weight he parin [16], which is longer than that of heparin, should be 380 A k iz aw a / K oshika w a / O t a / K a z a m a / M im u ra /H ira s a w a FUT-175, Regional Anticoagulant for HD considered another disadvantage in preventing increases in bleeding.…”

Section: Discussionmentioning

confidence: 99%

Nafamostat Mesilate: A Regional Anticoagulant for Hemodialysis in Patients at High Risk for Bleeding

Akizawa

Koshikawa

et al. 1993

Nephron

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107 hemodialysis patients at high risk for intradialytic bleeding due to previous surgery or active bleeding from other sites were treated with nafamostat mesilate (FUT-175; FUT) as hemodialysis anticoagulant for 2 weeks. In contrast to heparin. FUT prolonged clotting times only in the extracorporeal circuit. Clotting times were not prolonged even at the conclusion of the treatment, and bleeding from the puncture site after removal of the needle was shorter than with heparin. The exacerbation of bleeding by hemodialysis was noted in only 21 out of 573 hemodialysis procedures (3.7%), and 134 of 145 hemodialysis procedures (92.4%) with active bleeding were successfully completed without increasing the bleeding. Adverse effects of FUT were noted in only 6 cases (5.6%) or 1.2% of HD procedures. These results indicate that FUT is a very useful anticoagulant for HD, especially in patients with high risk of bleeding.

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“…If signs and symptoms of uremia still developed following use of HF only, use of hemodiafiltration (HDF) was considered, but was required in only one patient (Case 36). HD three times a week using a dialyzer (FB  ; Nipro) and low molecular weight heparin as anticoagulant 16) was not instituted in patients with either ICH or SAH until HF had been confirmed to cause no neurological deterioration. Treatment algorithms are provided in Fig.…”

Section: Blood Purification After Admissionmentioning

confidence: 99%

Clinical Features and Management of Intracranial Hemorrhage in Patients Undergoing Maintenance Dialysis Therapy

Murakami

Hamasaki

Kimura

et al. 2004

Neurol. Med. Chir.(Tokyo)

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The management and outcome were retrospectively investigated in patients with chronic renal failure receiving maintenance blood purification who suffered intracranial hemorrhage. Patients with intracerebral hemorrhage (ICH, n ＝ 36) or subarachnoid hemorrhage (SAH, n ＝ 5) were evaluated. Both groups were initially managed using continuous hemofiltration (HF) after admission, except for two patients with SAH receiving maintenance peritoneal dialysis. Patients with ICH were managed with HF three times a week after computed tomography showed decreased peripheral edema. Nafamostat mesilate was used as the anticoagulant for both continuous HF and HF. Hemodialysis (HD) three times a week was initiated after confirming the absence of neurological deterioration using HF. Craniotomy was not performed in any patient with ICH, but if necessary, the hematoma was aspirated using burr-hole surgery. Angiography was performed on the day of admission in patients with SAH. Delayed neck-clipping surgery was performed after continuous HF for 2 weeks with lumbar cerebrospinal fluid drainage. In patients with ICH, continuous HF was continued for 2-9 days after admission (mean 5.2 ± 2.2 days), followed by 2-9 courses of HF (mean 4.7 ± 2.1 courses). HD was initiated 9-26 days after admission (mean 15.5 ± 4.6 days). Favorable outcomes were achieved by 13 of the 36 patients with ICH and two of the five patients with SAH, whereas 22 patients with ICH and three patients with SAH died. Death occurred in 12 of 16 patients with ICH and diabetic nephropathy. In contrast, 10 of 20 non-diabetic patients with ICH had favorable outcomes. Ten of the 16 patients with initial GCS Ã8 and six of the 20 with GCS AE9 were diabetic. Therefore, there were significant differences between diabetic and non-diabetic patients (p ＝ 0.05). Poor outcomes in diabetic patients with ICH are caused by primary brain damage, reflected in the initial disturbance of consciousness.

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Low molecular weight heparin in hemodialysis and hemofiltration patients

Cited by 58 publications

References 27 publications

Low-Molecular-Weight Heparin Fraxiparin® in Chronic Hemodialysis

Low-Molecular-Weight Heparin Fraxiparin® in Chronic Hemodialysis

Nafamostat Mesilate: A Regional Anticoagulant for Hemodialysis in Patients at High Risk for Bleeding

Clinical Features and Management of Intracranial Hemorrhage in Patients Undergoing Maintenance Dialysis Therapy

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