title: Clinical study on low-molecular weight heparin infusion as anticoagulation for nocturnal home haemodialysis.
abstract: OBJECTIVE
  This study was conducted to evaluate low-molecular weight heparin (LMWH) as anticoagulation for nocturnal home haemodialysis (NHHD). While its longer half-life may cause drug accumulation in frequent dialysis, the essential need of a supplementary intra-dialytic bolus for the sleeping patients also renders LMWH's use impractical.
  
  
  METHODS
  The recruited patients, who were on alternate-day 8 h haemodialysis, were randomized to receive either nadroparin or unfractionated heparin (UFH) for a week. They underwent crossover to receive the alternate anticoagulant in the next week. A nadroparin infusion regimen was adopted to enhance its practicability, which consisted of a loading dose of 35 IU/kg and a continuous infusion of 10 IU/kg per hour for 6 h.
  
  
  RESULTS
  A total of 12 NHHD patients were recruited. With nadroparin infusion, the mean anti-Xa levels at the 2nd, 4th, 6thand 8thhours of dialysis were 0.46 ± 0.11, 0.55 ± 0.14, 0.61 ± 0.15 and 0.45 ± 0.15 IU/mL respectively. Comparing to UFH, which offered satisfactory anticoagulation according to the activated partial thromboplastin time, nadroparin-treated dialysis achieved similar thrombus scores and dialyser urea/creatinine clearances at the end of haemodialysis. During the post-dialysis period, one patient demonstrated residual LMWH effect (anti-Xa level 0.09 IU/mL) on the next day, whereas none had detectable anti-Xa activities 2 days afterwards upon next dialysis.
  
  
  CONCLUSIONS
  Low-molecular weight heparin infusion is practical and effective as anticoagulation for NHHD. It can be safely used in an alternate-day haemodialysis schedule. A close monitoring for LMWH accumulation is recommended if long dialysis is performed daily.
authors.affiliation: Department of Medicine, Alice Ho Miu Ling Nethersole Hospital.
authors.forename: Steve Siu-Man
authors.initials: SS
authors.lastname: Wong
authors.affiliation: Department of Medicine, Alice Ho Miu Ling Nethersole Hospital.
authors.forename: Wai-Yan
authors.initials: WY
authors.lastname: Lau
authors.affiliation: Department of Medicine, Alice Ho Miu Ling Nethersole Hospital.
authors.forename: Man-Luen
authors.initials: ML
authors.lastname: Ng
authors.affiliation: Department of Medicine, Alice Ho Miu Ling Nethersole Hospital.
authors.forename: Shuk-Yin
authors.initials: SY
authors.lastname: Chan
authors.affiliation: Department of Medicine, Alice Ho Miu Ling Nethersole Hospital.
authors.forename: So-Fan
authors.initials: SF
authors.lastname: Chan
authors.affiliation: Department of Medicine, Alice Ho Miu Ling Nethersole Hospital.
authors.forename: Ping-Kwan
authors.initials: PK
authors.lastname: Chan
authors.affiliation: Department of Medicine, Alice Ho Miu Ling Nethersole Hospital.
authors.forename: Ching-Kit
authors.initials: CK
authors.lastname: Wan
authors.affiliation: Department of Medicine, Alice Ho Miu Ling Nethersole Hospital.
authors.forename: Yuk-Lun
authors.initials: YL
authors.lastname: Cheng
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001777:Blood Coagulation / Q000187:drug effects*; D018592:Cross-Over Studies; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006437:Hemodialysis, Home / Q000009:adverse effects / Q000379:methods*; D006723:Hong Kong; D006801:Humans; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D017762:Nadroparin / Q000008:administration & dosage* / Q000009:adverse effects; D010314:Partial Thromboplastin Time; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D017762:Nadroparin
keywords: Anticoagulation; home haemodialysis; low-molecular weight heparin; nadroparin; unfractionated heparin