title: Comparison of unfractionated heparin and low molecular weight heparin during long-term use in chronic haemodialysis and haemofiltration patients.
abstract: Antithrombotic activity, necessary doses and effects on coagulation and lipid variables of the low molecular weight heparin derivative Fragmin were compared to unfractionated (UF) heparin in long-term multicentre trials. Results of more than 10,000 dialyses are reported. On the basis of preliminary studies, UF heparin and Fragmin doses were used that lead to anti-Xa activities of more than 0.5 U/ml. With this dose, sufficient antithrombotic activity was achieved with both heparins. Bleeding complications were not noticed. Partial thromboplastin time (PTT) and thrombin time were only marginally increased by Fragmin (5-8 s) in contrast to UF heparin (PTT 90-120 s, thrombin time 230-260 s). Surprisingly, the elevated levels of factor VIII strongly decreased during the 6-month treatment period with Fragmin and increased again during the following 6-month treatment period with UF heparin. Creatinine, urea, haemoglobin and transaminases did not change in both heparin groups: this excluded reduced dialysis efficiency or occult blood loss. Additionally, 15 patients with acute renal failure and high bleeding risk were dialysed with low doses of Fragmin (anti-FXa: 0.2-0.3 U/ml). No severe bleeding occurred. A continuous ambulant peritoneal dialysis patient with deep vein thrombosis was treated effectively with intraperitoneal application of Fragmin for 6 months without any problems.
mesh_terms: D058186:Acute Kidney Injury / Q000188:drug therapy; D001769:Blood; D005169:Factor VIII / Q000032:analysis; D005170:Factor X / Q000502:physiology; D015951:Factor Xa; D006493:Heparin / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007274:Injections, Intraperitoneal; D007279:Injections, Subcutaneous; D007676:Kidney Failure, Chronic / Q000188:drug therapy; D010314:Partial Thromboplastin Time; D006435:Renal Dialysis; D013927:Thrombosis / Q000453:epidemiology / Q000517:prevention & control; D014462:Ultrafiltration
chemical_list: D005169:Factor VIII; D005170:Factor X; D006493:Heparin; D015951:Factor Xa