The Effectiveness of a Low Molecular Weight Heparinoid in Chronic Intermittent Haemodialysis

Summary

A new low molecular weight heparinoid, Org 10172 was compared to heparin in a randomized single blind cross-over study in 55 patients with end-stage renal failure undergoing chronic intermittent haemodialysis. The heparinoid administered as a single pre-dialysis i. v. injection of 34.4 anti-Xa units/kg body weight was compared to standard heparin (loading dose 2,500 IU + continuous infusion of 1,800 IU/hr). Mean anti-Xa plasma levels reached were 0.55 and 0.94 anti-Xa units/ml midway dialysis respectively. All 110 dialysis procedures were successfully performed without clotting or bleeding complications. Analysis of the number of clotted hollow-fibres within the dialysers showed a slight statistically calculated advantage in favour of heparin. Clinically no difference was detected. In conclusion, the heparinoid seems to be a good alternative means of anticoagulation in haemodialysis. As it is administered as a single i.v. pre-dialysis injection it will simplify the dialysis procedure.

Keywords

Chronic intermittent haemodialysis - LMW heparinoid

• References

• 1 Maher JF, Schreiner GE. Hazards and complications of dialysis. N Engl J Med 1965; 723: 370-377
• 2 Mason RG, Chung HYK, Mohammad SF, Sharp DE. Extracorporeal thrombogenesis and anticoagulation. In: Drukker W, Parsons FM, Maher JF. eds. Replacement of renal function by dialysis. Boston: Martinus Nijhoff; 1978: 199-216
• 3 Lazarus JM. Complications of hemodialysis. Kidney Int 1981; 18: 783-796
• 4 Leonard CD, Weil E, Scribner BH. Subdural haematomas in patients undergoing haemodialysis. Lancet 1969; 02: 239
• 5 Milotinovick J, Follette WC, Scribner BH. Spontaneous retroperitoneal bleeding in patients on chronic hemodialysis. Ann Intern Med 1977; 86: 189-192
• 6 Galen MA, Steinberg SM, Lowrie EG, Lazarus JM, Hampers CL, Merrill JP. Hemorrhagic pleural effusion in patients undergoing chronic hemodialysis. Ann Intern Med 1975; 82: 359-361
• 7 Maher JF, Lapiere L, Schreiner GE, Geiger M, Westervelt FB. Regional heparinization for hemodialysis. N Engl J Med 1963; 268: 451-456
• 8 Swartz RD, Port FK. Preventing hemorrhage in high risk hemodialysis. Regional versus low-dose heparin. Kidney Int 1979; 16: 513-518
• 9 Swartz RD. Hemorrhage during high-risk hemodialysis using controlled heparinisation. Nephron 1981; 28: 65-69
• 10 Gotch FA, Keen ML. Precise control minimal heparinisation for high bleeding risk hemodialysis. Trans Am Soc Artif Intern Org 1977; 23: 168-175
• 11 Gunnarsson B, Asaba H, Dawidson S, Wilhelmsson S, Bergström J. The effect of different heparin regimes on heparin concentrations in plasma and fibrin formation in dialyzers. Clin Nephrol 1981; 15: 135-142
• 12 Zusmann RM, Rubin RH, Cato AE, Cocchetto DM, Crow JW, Tolkoff-Rubin N. Hemodialysis using prostacyclin instead of heparin as the sole antithrombotic agent. N Engl J Med 1981; 304: 934-939
• 13 Smith MC, Danviriyasup K, Crow JW, Cato AE, Park GD, Hassid A, Dunn MJ. Prostacyclin substitution for heparin in long-term hemodialysis. Am J Med 1982; 73: 669-678
• 14 Turney JM, Weston MJ. Dialysis without anticoagulants. Lancet 1981; 2: 693
• 15 Ivanovich P, Xu CG, Kwaan HC, Hathiwala S. Studies of coagulation and platelet functions in heparin-free hemodialysis. Nephron 1983; 33: 116-120
• 16 Meuleman DG, Hobbelen PMJ, van Dedem G, Moelker HCT. A novel antithrombotic heparinoid (Org 10172) devoid of bleeding inducing capacity: A survey of its pharmacological properties in experimental animal models. Thromb Res 1982; 27: 353-363
• 17 Böller HR, Hobbelen PMJ, Princen AWN, Moelker HCT, ten Cate JW. The effects of high plasma antithrombin III levels in the presence and absence of heparin on the bleeding tendency using an experimental model in rats.Observations on a novel natural heparinoid. Thromb Res 1983; 31: 787-797
• 18 ten Cate H, Henny ChP, Mooy MC, ten Cate JW, Surachno S, Wilmink JM. The anticoagulant and antithrombotic effects of a novel heparinoid in haemodialysis patients and human volunteers. Thromb Haemostas 1983; 50: 302 (Abstr)
• 19 Henny ChP, ten Cate H, ten Cate JW, Surachno S, van Bronswijk H, Wilmink JM, Ockelford PA. Use of a new heparinoid as anticoagulant during acute haemodialysis of patients with bleeding complications. Lancet 1983; 1: 890-893
• 20 ten Cate H, Henny ChP, Biiller HR, ten Cate JW, Magnani HN. Use of a heparinoid in patients with hemorrhagic stroke and thromboembolic disease. Ann Neurol 1984; 15: 268-270
• 21 Bangham DR, Woodward PM. A collaborative study of heparins from different sources. Bull Wrld Hlth Org 1970; 42: 129-149
• 22 ten Cate H, Lamping RJ, Henny ChP, Prins A, ten Cate JW. Automated amidolytic method for determining heparin, a heparinoid, and low-Mr heparin fragment, based on their anti-Xa activity. Clin Chem 1984; 30: 860-864