Haemodialysis in patients treated with oral anticoagulant: should we heparinize?
BACKGROUND
Anticoagulation for the haemodialysis circuit in patients treated with oral anticoagulation poses additional haemorrhagic risk. The few available data suggest that tapering or even stopping heparinization is feasible and the HeprAN membrane with grafted heparin was developed to decrease heparin dose. The objective of our study was to evaluate the need for additional anticoagulation in patients on long-term oral anticoagulation, according to the type of membrane used.


METHODS
This is a prospective, randomized, crossover bifactorial trial in haemodialysed patients on oral anticoagulation. Each patient had four haemodialysis sessions with two different membranes [HeprAN or polysulphone (PS)] and with or without enoxaparin. Clinical coagulation was evaluated by the need for premature ending and by a visual score (Janssen scale). Coagulation activation markers were also measured: d-dimers, prothrombin fragments 1 + 2, thrombin-antithrombin complexes, tissue factor pathway inhibitor and platelet factor-4.


RESULTS
Ten patients were included (M/F = 4/6, mean age 63 ± 15 years). None of the 40 sessions ended prematurely. The clotting scores were similar with or without enoxaparin (dialyser: 1.49 ± 0.19 versus 1.53 ± 0.17, P = 0.97; bubble trap: 0.75 ± 0.19 versus 0.78 ± 0.22, P = 0.62) and with the polysulphone or the HeprAN membrane (dialyser: 1.54 ± 0.20 versus 1.47 ± 0.16, P = 0.65; bubble trap: 0.74 ± 0.22 versus 0.79 ± 0.19, P = 0.58). There was no significant difference in coagulation activation markers between dialysis modalities; however, dialysis efficacy was significantly greater with the PS membrane (1.58 ± 0.07 versus 1.43 ± 0.06, P = 0.02).


CONCLUSIONS
These results suggest that haemodialysis without additional anticoagulation is possible in patients with oral anticoagulation. The HeprAN membrane did not provide any additional benefit compared with a PS membrane.
Department of Nephrology, University Hospital and School of Medicine, Strasbourg, France.
Thierry
T
Krummel
Elise
E
Scheidt
Claire
C
Borni-Duval
Dorothée
D
Bazin
François
F
Lefebvre
Philippe
P
Nguyen
Thierry
T
Hannedouche
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001777:Blood Coagulation / Q000187:drug effects; D018592:Cross-Over Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011516:Prothrombin; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D012307:Risk Factors; D013927:Thrombosis / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
D000925:Anticoagulants; D011516:Prothrombin
chronic haemodialysis; coagulation; haemodialysis membrane; low molecular weight heparin; oral anticoagulation