Different effects of enoxaparin, nadroparin, and dalteparin on plasma TFPI during hemodialysis: a prospective crossover randomized study.
BACKGROUND
Low-molecular-weight heparins (LMWHs) are an alternative to unfractionated heparin (UFH) for anticoagulation during hemodialysis (HD). We performed a prospective randomized crossover study of the effect of enoxaparin, nadroparin, and dalteparin on some hemostatic factors, including tissue factor pathway inhibitor (TFPI), in patients with maintenance HD.


METHODS
Plasma levels (immunoassays) of total TFPI, platelet-derived growth factor-AB (PDGF-AB), and prothrombin fragment 1 + 2 (PF 1 + 2) were evaluated pre-HD, after 10 (T10) and 180 (T180) minutes of HD in 21 patients, who completed a 3-period (for 2 months each) crossover study in 6 groups (Latin-square design).


RESULTS
The baseline TFPI, PDGF-AB, and PF 1 + 2 levels were comparable under all LMWH treatments. Tissue factor pathway inhibitor levels, compared with the baseline, significantly increased (all P < 10(-4)), whereas PDGF-AB levels remained stable at each interval during enoxaparin, nadroparin, and dalteparin anticoagulated HD. Interestingly, TFPI increment at T10 was the highest, dose-dependent, and accompanied by PF 1 + 2 decrease under enoxaparin administration.


CONCLUSIONS
The switch from enoxaparin to nadroparin and dalteparin used as anticoagulants had no long-term effect on the baseline total TFPI and PF 1 + 2 levels in chronically HD patients. Only short-term, overdialytic differences were noticed, indicating a single bolus of enoxaparin (0.75 mg/kg) as the most potent stimulus for endothelial TFPI.
Naumnik
Beata
B
Department of Nephrology and Transplantation with Dialysis Unit, Medical University, Białystok, Poland. bnaumnik@poczta.onet.pl
Rydzewska-Rosołowska
Alicja
A
Myśliwiec
Michał
M
D000328:Adult; D000368:Aged; D018592:Cross-Over Studies; D017985:Dalteparin / Q000008:administration & dosage* / Q000009:adverse effects; D017984:Enoxaparin / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008074:Lipoproteins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D017762:Nadroparin / Q000008:administration & dosage* / Q000009:adverse effects; D010446:Peptide Fragments / Q000097:blood; D010982:Platelet-Derived Growth Factor / Q000378:metabolism; D011446:Prospective Studies; D011516:Prothrombin; D006435:Renal Dialysis
D017984:Enoxaparin; D005343:Fibrinolytic Agents; D008074:Lipoproteins; D017762:Nadroparin; D010446:Peptide Fragments; D010982:Platelet-Derived Growth Factor; C051928:lipoprotein-associated coagulation inhibitor; C095477:platelet-derived growth factor AB; C045879:prothrombin fragment 1.2; D011516:Prothrombin; D017985:Dalteparin