A safety and efficacy evaluation of single infusion of low molecular weight heparin for hemodialysis patients
| Autor: | Yu-Tung Lee, 李宇騰 |
|---|---|
| Rok vydání: | 2010 |
| Druh dokumentu: | 學位論文 ; thesis |
| Popis: | 98 Background: Low molecular weight heparin (LMWH) is an alternative to conventional unfractionated heparin (UFH) for anticoagulation during hemodialysis therapy. It is still controversial concerning about which kind of LMWH is more suitable to hemodialysis patients, and there is also no study to compare Enoxaparin with other LMWH in hemodialysis patients. We therefore performed a prospective study to compare the anti-factor Xa activity (anti-Xa), clinical performance and safety, between conventional heparin, Enoxaparin and Tinzaparin in 75 regular hemodialysis patients. Methods: As a matched control experimental design (matching factor: Age and Sex), all the 75 patients were assigned to 3 groups: Tinzaparin group (n=25), keeping their original Tinzaparin dosage with a single intravenous bolus before hemodialysis; Heparin group (n=25), keeping their original heparin dose with a single pre-dialysis intravenous bolus and then continuous drip for 3.5 hours; and Enoxaparin group (n=25), using the same dosage of Enoxaparin to replace their original total heparin dosage, giving with a single pre-dialysis intravenous bolus. Anti-Xa activity was measured before the start of hemodialysis therapy, end of 4 hours, and then 48 hours after the first dose. The complications including artificial kidney clotting and bleeding events during this 48-hour interval were all recorded. Results: The average dosages of anticoagulant were 36.82 ± 7.15 U/Kg in Tinzaparin group; 27.11 ± 5.98 U/Kg in Heparin group; and 34.32 ± 8.93 U/Kg in Enoxaparin group. The increments of anti-Xa activity after 4 hours of hemodialysis were significantly higher in Enoxaparin group compared with Tinzaparin group (0.43 ± 0.29 vs. 0.20 ± 0.21 IU/ml by anticoagulant 10000U/Kg, p= 0.010). There was no significant difference between Enoxaparin and Heparin groups, and also between Heparin and Tinzaparin groups. The analysis of the increments of anti-Xa activity 48 hours after showed the same trends as above. Concerning the clinical effects, Heparin group presented more bleeding events rate (16.0%), which is significantly higher than that of Tinzaparin group and Enoxaparin group. However, there was no significant difference between 3 groups in artificial kidney clotting rate. Conclusion: Our present study demonstrated that a single low dose of LMWH provides the same anti-coagulant effect as that of conventional heparin, sustains more than 4 hours, and do not increase the risk of bleeding. The LMWH is safe and effective in hemodialysis therapy. Concerning the efficacy in the increment of anti-Xa activity, Enoxaparin seems to be better than Tinzaparin。 |
| Databáze: | Networked Digital Library of Theses & Dissertations |
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