title: [Appropriate dosage of unfraction heparin and low molecular weight heparin in hemodialysis patients].
abstract: OBJECTIVE
  To investigate the appropriate dose of unfraction heparin and low molecular weight heparin (LMWH) in hemodialysis patients.
  
  
  METHODS
  Thirty-eight hemodialysis patients were enrolled and randomly allocated into four groups.The initial bolus dose for the Low-dose (LH, n = 10) and high-dose heparin (HH, n = 10) groups were 35 U/kg and 55 U/kg, respectively.The repeated maintenance dose for both groups were 10 U/kg.h and 16 U/kg.h, respectively. Fragmin were administered as single bolus (60 U/kg or 80 U/kg) at 30 minutes before hemodialysis in Low-dose LMWH(LLMWH, n = 10) and High-dose LMWH (HLMW, n = 8) group, respectively. Furthermore, the dialysis circuits in LUFH and LLMWUFH groups were primed with with 4 mg/dl heparinized saline before hemodialysis. Glass bead active clotting time (gbACT), clot rate (CR) and platelet function (PF) were examined using Sonoclot analysator at 0 h, 2 h and the end of hemodialysis at the arterial circuit and 2 h at the venous circuit.
  
  
  RESULTS
  (1) LH and LUFH: the increase of gbACT and decrease of CR at the arterial circuit and the venous circuit at 2 h of hemodialysis were significant compared with baseline. While they recovered at the end of hemodialysis. No difference between the two groups at different time points was found, either. (2) LLMWH: No change were found in gbACT during hemodialysis. CR at the arterial circuit and the venous circuit were significantly decreased at 2 h and recovered at the end of hemodialysis. (3) LLMWUFH: gbACT at the arterial circuit was significantly increased only at 2 h of hemodialysis. CR at the arterial circuit and the venous circuit at 2 h of hemodialysis were significantly decreased and recovered when hemodialysis finished. (4) HH and HLMWH: gbACT were significantly increased and CR were rapidly decreased at both the arterial circuit and venous circuit at 2 h of hemodialysis.
  
  
  CONCLUSIONS
  Low-dose heparin was effective and safe as anticoagulant in hemodialysis. Low-dose low-molecular-weight heparin was efficient in anticoagulation to some extent. However, High-dose low-molecular-weight heparin, high-dose heparin and flushing with heparinized saline may increase the risk of hemorrhage.
authors.affiliation: Institute of Nephrology, General Hospital of Chinese People's Liberation Army, Beijing 100853, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Xiao
authors.forename: Xue-feng
authors.initials: XF
authors.lastname: Sun
authors.forename: Dong
authors.initials: D
authors.lastname: Zhang
authors.forename: Zhi-fang
authors.initials: ZF
authors.lastname: Ma
authors.forename: Ming-ge
authors.initials: MG
authors.lastname: Wu
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
authors.forename: Xiang-mei
authors.initials: XM
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D006493:Heparin