Randomised Long-Term Comparison of Tinzaparin and Dalteparin in Haemodialysis

Beijering, R. J. R.; Cate, Hugo Ten; Stevens, Paul E.; Vanholder, Raymond; Dorp, W.T. van; Olden, R. W. van; B, Wickstrøm; Sprøgel, P; Cate, J. W. Ten

doi:10.2165/00044011-200323020-00002

Cited by 15 publications

(34 citation statements)

References 21 publications

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“…The design of the included studies included 10 randomized open trials using a crossover design (11,28,30,32,34 -36,38 -40), one blinded crossover trial (38), and six open trials using a parallel design (29,31,33,(41)(42)(43) (Table 1). Studies ranged in size from eight to 149 patients.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Three studies included patients who were receiving hemofiltration (29,35,39). Six studies permitted dose adjustments according to bleeding symptoms and/or extracorporeal circuit thrombosis; the mean LMWH dose is reported for these studies (29,34,36,40,41,43). A run-in phase was used in two studies, in which an individualized (optimal) LMWH dose was determined before (43) or after randomization (31).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Two studies were dose-finding studies (30,32). In three studies, the patient's hematocrit or duration of hemodialysis determined the initial LMWH dose (31,34,43). One study used therapeutic-dose enoxaparin (1 mg/kg) and subsequently decreased the mean dose to 0.69 mg/kg (slightly above prophylactic range) after frequent minor access site bleeding was noted (36).…”

Section: Study Characteristicsmentioning

confidence: 99%

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

Lim¹,

Cook²,

Crowther³

2004

Journal of the American Society of Nephrology

154

128

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Abstract. Low molecular weight heparins (LWMH) are the preferred initial treatment for many thromboembolic disorders but are renally excreted and relatively contraindicated in patients with renal failure because of concerns of increased bleeding risks. The purpose of this study was to evaluate the safety and efficacy of LMWH compared with unfractionated heparin (UFH) for preventing thrombosis of the extracorporeal dialysis circuit. Studies were identified with the use of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and FirstSearch; reference lists were reviewed; and pharmaceutical companies were contacted. Randomized, controlled trials that compared an LMWH with another anticoagulant during hemodialysis in patients with ESRD and reported at least one of bleeding, extracorporeal circuit thrombosis, or anti-Xa levels were chosen. Two reviewers independently extracted data on methodologic quality, study design, clinical outcomes, and anti-Xa levels. Seventeen trials were included in this systematic review, 11 of which were included in the meta-analysis. It was found that LMWH did not significantly affect the number of bleeding events (relative risk, 0.96; 95% confidence interval [CI], 0.27 to 3.43), bleeding assessed by vascular access compression time (weighted mean difference, Ϫ0.87; 95% CI, Ϫ2.75 to 1.02), or extracorporeal circuit thrombosis (relative risk, 1.15; 95% CI, 0.70 to 1.91) as compared with UFH.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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

Lim¹,

Cook²,

Crowther³

2004

Journal of the American Society of Nephrology

154

128

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“…A previous report revealed few details about the direct comparison of two different LMWHs for use in HD patients. [14][15][16] However, no study compared the safety and efficacy of nadroparin and enoxaparin for HD patients except for one animal study. 25 Unfractionated heparin is still routinely used in Taiwan as well as North America.…”

Section: Discussionmentioning

confidence: 99%

“…Usage of a LMWHinduced whole-general disorder or allergy is rare. 15 Two patients changed LMWH to unfractionated heparin due to general discomfort (one using nadroparin) and easy bleeding from the puncture site (one using enoxaparin). It is possible that some HD patients do not know when intermittent subcutaneous bleeding occurs due to excessive LMWH dosages.…”

Section: Patient Characteristics/nadroparinmentioning

confidence: 99%

Clinical Safety and Anticoagulation Efficacy of Low-Molecular-Weight Heparins in Chronic Hemodialysis Patients: A Single Medical Center Experience

et al. 2011

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Background: In many countries low-molecular-weight heparins (LMWHs) are increasingly used for hemodialysis (HD). Low-range activated clotting time (ACT-LR) values and anti-Xa activity had been used to monitor the degree of anticoagulation caused by LMWH. However, the facilities are not easily available at most hospitals. Such data are limited in Taiwan. Methods: A total of 76 patients receiving maintenance HD were prospectively enrolled. The HD patients were randomized to receive either nadroparin or enoxaparin and checked the ACT-LR values and anti-Xa activity. We aimed to analyze ACT-LR values and anti-Xa activity along with the clotting of the dialyzer or bleeding events associated with two LMWHs after they were administered. We also aimed to determine the dose necessary to reach maximum safety and efficacy. Results: We found no significant differences in LMWH dosage, ACT-LR values, and anti-Xa activity between the two groups. There were no significant differences in bleeding/adverse events and extracorporeal circuit thrombosis between the two groups. Most of the bleeding and adverse events were subcutaneous minor bleeding. No major bleeding or mortality was found. We found significant differences in mean dosage, cost, bleeding/adverse effect, and extracorporeal circuit thrombosis between excessive and reduced nadroparin dosage groups. Conclusion: LMWH is not still routinely used due to its high cost in Taiwan. In our clinical experience, nadroparin and enoxaparin exhibited high levels of safety and efficacy in chronic HD patients. Reduced LMWHs dosage could promote patient's safety and decreased HD cost in HD patients with excessive dosage of LMWHs.

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