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Article Review/Hyperlink |
Lai KN, Wang AYM, Ho K, Szeto CC, Li M, Wong LKS, Yu AWY
Use of low-dose, low molecular weight heparin in hemodialysis
Am J Kidney Dis (Nov) 28:721-726 1996
Low molecular weight heparin is widely used in Europe, whereas unfractionated heparin remains the standard of therapy in the United States. Potential advantages of LMW heparin include less effect on triglyceride levels, single-dose administration with longer-biologic half-life, a lower dose of bleeding, and a lower incidence of thrombocytopenia.
This study from Hong Kong is a dose finding study. A small number of patient (n=10) was dialyzed using unfractionated heparin for 2 weeks, and then LMW heparin (nadroparin) for 4 weeks, starting with a dose of 200 aXaU IC/kg (anti-Xa units Institute Choay) and then reducing the dose in a stepwise fashion by 25 aXaU IC/kg to 125 aXAU IC/kg. Plasma APTT, anti-Xa activity, and fiber bundle volume changes were monitored (Cuprophan dialyzers, no reuse, Qb = only 175 ml/min!).
A dose-dependent increase in factor anti-Xa level was present, with minimal effect on the APTT, as expected. The decrease in fiber bundle volume was trivial, and perhaps increased slightly to minus 3% at the lowest LMW heparin dose. The conclusions of the study are, that LMW heparin can be used, and that the dose should probably be greater than 125 Axau IC/kg, except in patients at risk for bleeding. Comment: This is a small study, difficult to interpret. US centers need to know the effects of LMW heparin on reuse number, and we all need a study of a large number of patients to properly assess the incidence of bleeding risk. (John T. Daugirdas, M.D., University of Illinois at Chicago)
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