Standard heparin versus low-molecular-weight heparin. A medium-term comparison in hemodialysis.
BACKGROUND
To compare standard heparin (SH) and low molecular weight heparin (LMWH) in terms of anticoagulation, platelet activation and lipid metabolism, we selected 54 patients who had been on 4-hour hemodialysis three times weekly for at least 12 months, without bleeding disorders or dyslipidemic diseases. 28 were on hemodialysis with Polysulfone low-flux, 26 were on hemodiafiltration with Polysulfone high-flux. All patients underwent EPO.


METHODS
During the first 18 months, we administered SH 1,500 IU on starting dialysis and 1,500 +/- 500 IU in continuous intradialytic infusion per session. In the following 18 months, we administered LMWH 64.6 IU/kg on starting dialysis in a single arterious bolus. We assessed aPTT, anti-factor Xa activity, TAT and FPA, beta-TG and PF4. Blood samples were taken monthly at times 0, 30, 60, 180 and 240 min, as well as 1, 4 and 20 h after dialysis end. Predialysis cholesterol, HDL, LDL, triglycerides and lipoprotein(a) were checked monthly.


RESULTS
During both LMWH and SH sessions no clotting or major bleeding complications were observed. APTT with LMWH was lower than that found with SH (p < 0.001); aFXa using LMWH was higher than when using SH (p < 0.001); TAT and FPA were lower in LMWH sessions (p < 0.01) than in SH sessions. We also detected lower beta-TG (p < 0.05) and PF4 levels (p < 0.05) using LMWH than using SH. As regards lipids, we only observed a significant decrease in triglycerides after 18 months of LMWH treatment.


CONCLUSIONS
Routine use of LMWH during hemodialysis affords a safe and effective alternative to SH, and causes reduced platelet activation.
Stefoni
Sergio
S
Nephrology Dialysis and Renal Transplantation Unit, Department of Clinical Medicine and Applied Biotechnology, S. Orsola University Hospital, Bologna, Italy. sstefoni@almadns.unibo.it
Cianciolo
Giuseppe
G
Donati
Gabriele
G
Colì
Luigi
L
La Manna
Gaetano
G
Raimondi
Concettina
C
Dalmastri
Vittorio
V
Orlandi
Valentina
V
D'Addio
Franesca
F
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D000990:Antithrombin III / Q000032:analysis; D001777:Blood Coagulation / Q000187:drug effects; D018592:Cross-Over Studies; D015951:Factor Xa / Q000378:metabolism; D065427:Factor Xa Inhibitors; D005260:Female; D005344:Fibrinopeptide A / Q000032:analysis; D017583:Hemodiafiltration; D006493:Heparin / Q000008:administration & dosage*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy*; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010447:Peptide Hydrolases / Q000032:analysis; D015539:Platelet Activation / Q000187:drug effects; D010978:Platelet Factor 4 / Q000032:analysis; D006435:Renal Dialysis; D001620:beta-Thromboglobulin / Q000032:analysis
D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D006495:Heparin, Low-Molecular-Weight; D008055:Lipids; C046193:antithrombin III-protease complex; D001620:beta-Thromboglobulin; D005344:Fibrinopeptide A; D010978:Platelet Factor 4; D000990:Antithrombin III; D006493:Heparin; D010447:Peptide Hydrolases; D015951:Factor Xa