title: Low-molecular weight heparin infusion as anticoagulation for haemodialysis.
abstract: BACKGROUND
  Low-molecular weight heparin (LMWH) is commonly used as an anticoagulant for haemodialysis by a single-bolus injection. However, its application in extended haemodialysis has been infrequently studied. In particular, for nocturnal home haemodialysis patients sleeping throughout treatment, the need for additional intradialytic bolus might render the use of LMWH impractical. To overcome this limitation, we changed traditional bolus injections to continuous infusion. We first tested our method among in-centre 4-h haemodialysis patients to establish a feasible and safe infusion regimen before utilizing it in extended dialyses at home.
  
  
  METHODS
  Recruited patients were given nadroparin (standardized at 65 IU/kg) as an anticoagulant for haemodialysis. They were first randomized to receive nadroparin either by bolus injection or infusion. Afterwards, the patients underwent crossover to receive the alternate method of LMWH anticoagulation. The degrees of anticoagulation and bleeding complications were compared.
  
  
  RESULTS
  Sixteen haemodialysis patients were recruited. After nadroparin administration, anti-Xa levels at the first hour were significantly higher by the bolus than the infusion methods (0.68 ± 0.10 versus 0.49 ± 0.10 IU/mL, P < 0.001) and were similar by the second hour (0.56 ± 0.10 versus 0.55 ± 0.11 IU/mL, P = 0.64). At the sixth hour, anti-Xa levels by the infusion method were significantly higher (0.35 ± 0.13 versus 0.25 ± 0.10 IU/mL, P < 0.001), suggesting the infusion approach required a dosage reduction. There were no bleeding events reported in either method.
  
  
  CONCLUSIONS
  LMWH infusion is feasible and safe. The method avoids early excessive anticoagulation caused by bolus injection and reduces the LMWH dose. Future studies should be conducted to evaluate LMWH infusion in extended haemodialysis treatment.
authors.affiliation: Department of Medicine , Alice Ho Miu Ling Nethersole Hospital , 11 Chuen On Road, Tai Po, N.T. , Hong Kong.
authors.forename: Steve Siu-Man
authors.initials: SS
authors.lastname: Wong
authors.affiliation: Department of Medicine , Alice Ho Miu Ling Nethersole Hospital , 11 Chuen On Road, Tai Po, N.T. , Hong Kong.
authors.forename: Wai-Yan
authors.initials: WY
authors.lastname: Lau
authors.affiliation: Department of Medicine , Alice Ho Miu Ling Nethersole Hospital , 11 Chuen On Road, Tai Po, N.T. , Hong Kong.
authors.forename: Ping-Kwan
authors.initials: PK
authors.lastname: Chan
authors.affiliation: Department of Medicine , Alice Ho Miu Ling Nethersole Hospital , 11 Chuen On Road, Tai Po, N.T. , Hong Kong.
authors.forename: Ching-Kit
authors.initials: CK
authors.lastname: Wan
authors.affiliation: Department of Medicine , Alice Ho Miu Ling Nethersole Hospital , 11 Chuen On Road, Tai Po, N.T. , Hong Kong.
authors.forename: Yuk-Lun
authors.initials: YL
authors.lastname: Cheng
keywords: anticoagulation; continuous infusion; haemodialysis; low-molecular weight heparin; nadroparin