The Effectiveness of a Low Molecular Weight Heparinoid in Chronic Intermittent Haemodialysis

Abstract

SummaryA new low molecular weight heparinoid, Org 10172 was compared to heparin in a randomized single blind cross-over study in 55 patients with end-stage renal failure undergoing chronic intermittent haemodialysis. The heparinoid administered as a single pre-dialysis i. v. injection of 34.4 anti-Xa units/kg body weight was compared to standard heparin (loading dose 2,500 IU + continuous infusion of 1,800 IU/hr). Mean anti-Xa plasma levels reached were 0.55 and 0.94 anti-Xa units/ml midway dialysis respectively. All 110 dialysis procedures were successfully performed without clotting or bleeding complications. Analysis of the number of clotted hollow-fibres within the dialysers showed a slight statistically calculated advantage in favour of heparin. Clinically no difference was detected. In conclusion, the heparinoid seems to be a good alternative means of anticoagulation in haemodialysis. As it is administered as a single i.v. pre-dialysis injection it will simplify the dialysis procedure.

Treatment and Prevention of Heparin-Induced Thrombocytopenia

“…Small RCTs that compared danaparoid with heparin or LMWH during hemodialysis in patients without HIT have also shown it to be effective and safe. 154,155 Lepirudin and Fondaparinux: Lepirudin is dependent on renal clearance and antihirudin antibodies may develop that further reduce renal clearance. 156,157 Because of the prolonged half-life of this agent in renal failure, intermittent doses of lepirudin prior to dialysis may continue to exert an anticoagulant effect between dialysis sessions.…”

Newer Strategies for the Treatment of Heparin‐Induced Thrombocytopenia

“…Recurrence and extension of venous thrombi were significantly reduced in patients receiving danaparoid 2000 U intravenous loading dose followed by 2000 U subcutaneously twice/day compared with patients receiving intravenous UFH 2500 U intravenous loading dose followed by a continuous infusion with dosage adjustments. 70 The agent is a safe and effective anticoagulant in patients who require hemodialysis, 71,72 including those receiving hemodialysis for acute or chronic renal failure because of bleeding or high risk of hemorrhage. 73 Danaparoid is a rational alternative to heparin, with the advantage that it can be given as a single, intravenous, predialysis injection.…”

“…73 Danaparoid is a rational alternative to heparin, with the advantage that it can be given as a single, intravenous, predialysis injection. 71 Because it is predominantly eliminated by kidneys, regular administration in chronic renal failure may lead to progressive drug accumulation. 55 Therefore, dosage adjustments and monitoring of plasma anti-Xa levels may be required in patients with renal failure.…”

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

“…Fifty-five patients with end-stage renal disease undergoing hemodialysis were treated with heparin or danapranoid in a randomized single-blind crossover study. There was no difference in clinically relevant endpoints between the two groups [11]. Danapranoid has low cross-reactivity with the HIT antibody (approximately 10-20%) [1].…”