title: Dermatan sulfate: an alternative to unfractionated heparin for anticoagulation in hemodialysis patients.
abstract: BACKGROUND
  Unfractionated heparin (UFH) is the standard anticoagulant in regular dialysis treatments (RDTs), despite the fact that it may induce thrombocytopenia, dyslipidemia, allergy and osteoporosis. Dermatan sulfate (DS) selectively inhibits thrombin, does not inhibit F-Xa and does not interfere with platelets (PLTS). Here we described an original protocol for the use of DS as anticoagulant in RDT and compared its effects with those of UFH.
  
  
  METHODS
  In 102 patients, 7,254 RDTs were performed using DS for anticoagulation (DS-phase) and 5,707 with UFH (UFH-phase). DS was supplied as initial bolus (80 ± 12 mg) and continuous infusion (14 ± 7 mg/hour). With UFH, the initial bolus was 1,475 ± 141 IU and continuous infusion 576 ± 349 IU/hour. Activated partial thromboplastin time and its ratio were measured at least monthly, both before (pre-RDT APTT ratio) and after (post-RDT APTT ratio) RDT sessions. With 41 of 102 patients, both DS and UFH doses were not changed during study phases (stable patients). In this subset, the coefficient of variation (CV) of all pre-RDT APTT ratio and post-RDT APTT ratio values was calculated.
  
  
  RESULTS
  In DS and UFH phases, post-RDT APTT ratio increased by 61% and 50%, respectively, by comparison with pre-RDT APTT ratio (p<0.001). PLTS count was lower in the UFH than in the DS phase (p<0.01). In stable patients, post-RDT APTT ratio CV was lower in the DS than in the UFH phase (p<0.001), which indicates a more predictable anticoagulant effect of DS compared with UFH.
  
  
  CONCLUSIONS
  DS appeared as effective as UFH for anticoagulation in RDT. It can reliably be considered as an alternative approach especially in cases of thrombocytopenia or other adverse effects of UFH.
authors.affiliation: Nephrology and Dialysis Unit, Ordine Mauriziano Hospital, Turin, Italy. covitale@libero.it
authors.forename: Corrado
authors.initials: C
authors.lastname: Vitale
authors.forename: Silvia
authors.initials: S
authors.lastname: Berutti
authors.forename: Cristiana
authors.initials: C
authors.lastname: Bagnis
authors.forename: Giorgio
authors.initials: G
authors.lastname: Soragna
authors.forename: Paolo
authors.initials: P
authors.lastname: Gabella
authors.forename: Claudia
authors.initials: C
authors.lastname: Fruttero
authors.forename: Martino
authors.initials: M
authors.lastname: Marangella
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001777:Blood Coagulation / Q000187:drug effects; D016001:Confidence Intervals; D003871:Dermatan Sulfate / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies
chemical_list: D000925:Anticoagulants; D003871:Dermatan Sulfate; D006493:Heparin