Anticoagulation with low molecular weight heparin (Fragmin) during continuous hemodialysis in the intensive care unit.
A preparation of low molecular weight heparin (Fragmin) was administered to patients with multiorgan failure receiving continuous venovenous hemodialysis. Three patients received a high-dose regimen (35 IU/kg bolus followed by 13 IU/kg infusion), and 7 received a low-dose regimen (8 and 5 IU/kg, respectively) for 36 h. High-dose Fragmin was associated with minimal clotting in the extracorporeal circuit. Plasma fibrinopeptide A levels declined, and mean anti-Xa activity was in the range 0.47-0.79 IU/ml. The urea equilibration coefficient (UEC) (100% at initiation) remained above 90% throughout. All 3 patients had mild bleeding episodes, which led to discontinuation of Fragmin in 1. During all low-dose treatments, marked thrombus formation occurred in the extracorporeal circuit, and in 2, the circuit clotted within the study period. Fibrinopeptide A levels further increased in 4 patients, and mean anti-Xa activity was in the range 0.27-0.53 IU/ml. UEC declined appreciably in 3 treatments (including the 2 in which early circuit clotting occurred). One patient experienced a mild bleeding episode. The low-dose Fragmin regimen produced safer anticoagulation in patients at risk from bleeding and is suitable for prolonged renal support although the tendency to thrombosis may necessitate more frequent circuit changes.
Jeffrey
R F
RF
Department of Renal Medicine, Saint James's University Hospital, Leeds, United Kingdom.
Khan
A A
AA
Douglas
J T
JT
Will
E J
EJ
Davison
A M
AM
D058186:Acute Kidney Injury / Q000097:blood / Q000628:therapy; D000328:Adult; D000368:Aged; D001777:Blood Coagulation / Q000187:drug effects; D003422:Critical Care; D017985:Dalteparin / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005344:Fibrinopeptide A / Q000032:analysis; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D013927:Thrombosis / Q000517:prevention & control
D005344:Fibrinopeptide A; D017985:Dalteparin