A review of 122 published outcomes of danaparoid anticoagulation for intermittent haemodialysis.
One hundred and twenty-two case reports of treatment outcomes of danaparoid use for intermittent haemodialysis (HD) in severely ill patients with heparin intolerance (including 97 HIT patients) have been analysed. HD sessions of 4 - 6 hours were successfully conducted daily to 3 times/week for periods of up to 4 years (median 7 sessions/patient (range 1 - >650). In these patients danaparoid use was relatively safe (4 unprovoked non-fatal major bleeds) and efficacious in protecting the circuit (95% no clotting problem) or patient (6 thromboses: 4 fatal or leading to danaparoid discontinuation). HIT diagnosis was improved if recurrent platelet count reduction with each HD and circuit/AV graft clotting were included. Alternative reasons for and very low nadirs of the platelet count undermined the usefulness of the 4 T pre-test HIT predictability scores, but a positive functional serological test confirmed HIT in most patients. Deaths (15.6%) and thrombosis only occurred in HIT cases. Possible reasons are discussed. Replacing the standard intermittent pre-HD dose regimen with the therapeutic infusion regimen to provide continuous daily systemic antithrombotic protection, should further improve efficacy.


CONCLUSIONS
Danaparoid appears to be a useful alternative antithrombotic for patients with heparin intolerance and renal failure requiring haemodialysis.
Magnani
H N
HN
harry.magnani@hetnet.nl
D002809:Chondroitin Sulfates / Q000627:therapeutic use*; D003871:Dermatan Sulfate / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000188:drug therapy / Q000628:therapy; D006493:Heparin / Q000276:immunology / Q000627:therapeutic use*; D006497:Heparan Sulfate / Q000627:therapeutic use*; D006801:Humans; D010976:Platelet Count; D011247:Pregnancy; D012008:Recurrence; D006435:Renal Dialysis; D013927:Thrombosis / Q000188:drug therapy / Q000628:therapy; D016896:Treatment Outcome
D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D006493:Heparin; D006497:Heparan Sulfate; C035838:danaparoid