Low molecular weight heparin in hemodialysis patients with a bleeding tendency.
Efficacy and safety of a low-molecular-weight heparin (LMWH) were studied in 33 stable maintenance hemodialysis patients who had a bleeding tendency on unfractionated heparin. The optimal dose of LMWH for each patient was titrated before the study; the mean total LMWH dosage was 1,152 +/- 574 IU. No major bleeding or clot formation was noted in a total of 2,470 hemodialysis sessions during 6 months of LMWH administration. The mean value of plasma anti-factor Xa (anti-Xa) activity increased from 0.05 +/- 0.03 IU/ml before dialysis to 0.34 +/- 0.28 IU/ml after 2 h of dialysis and returned to 0.15 +/- 0.09 IU/ml after 4 h of dialysis; the mean activated partial thromboplastin time was 26.1 +/- 4.4 s before dialysis, 30.7 +/- 9.5 s (an 18% increase) after 2 h of dialysis, and 26.2 +/- 4.4 s after 4 h of dialysis. No significant change in serum antithrombin levels was noted throughout the whole study period. We conclude that a low dosage of LMWH is safe and effective in hemodialysis patients who have a risk of bleeding with unfractionated heparin. Serum anti-Xa activity is better than activated partial thromboplastin time and antithrombin in assessing the optimal dose of LMWH. A plasma anti-Xa activity of 0.37 IU/ml after 2 h of hemodialysis may represent an optimal dosage of LMWH for most patients.
Leu
J G
JG
Division of Nephrology, Department of Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan. jgleu@mailsrv.ym.edu.tw
Chiang
S S
SS
Lin
S M
SM
Pai
J K
JK
Jiang
W W
WW
D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D000991:Antithrombins / Q000378:metabolism; D065427:Factor Xa Inhibitors; D006470:Hemorrhage / Q000139:chemically induced*; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D010314:Partial Thromboplastin Time; D006435:Renal Dialysis; D015842:Serine Proteinase Inhibitors / Q000378:metabolism
D000925:Anticoagulants; D000991:Antithrombins; D065427:Factor Xa Inhibitors; D006495:Heparin, Low-Molecular-Weight; D015842:Serine Proteinase Inhibitors