Efficacy of enoxaparin in preventing coagulation during high-flux haemodialysis, expanded haemodialysis and haemodiafiltration
Por:
Santos, A, Macias, N, Vega, A, Abad, S, Linares, T, Aragoncillo, I, Cruzado, L, Pascual, C, Goicoechea, M and Lopez-Gomez, J
Publicada:
1 abr 2021
Ahead of Print:
22 jun 2020
Categoría:
Nephrology
Resumen:
Background. Low-molecular-weight heparins (LMWHs) are easily dialysable with high-flow membranes; however, it is not clear whether the LMWH dose should be adjusted according to the membrane type and dialysis technique. This study aimed to evaluate the influence of the dialyser on anticoagulation of the extracorporeal dialysis circuit.
Methods. Thirteen patients received the same dose of LMWH through the arterial port via three dialysis techniques: high-flux haemodialysis (HF-HD), online haemodiafiltration (HDF) and expanded haemodialysis (HDx). All dialysis was performed under similar conditions: duration, 4 h; blood flow, 400 mL/min; and dialysate flow, 500 mL/min. Antifactor Xa (aXa) activity and activated partial thromboplastin time (APTT) were measured before and after the dialysis. Clotting time of the vascular access site after haemodialysis, visual clotting score of the dialyser and any complications with the extracorporeal circuit or bleeding were registered.
Results. Post-dialysis aXa activity in HF-HD (0.26 +/- 0.02 U/mL) was significantly different from that in HDF (0.21 +/- 0.02 U/mL, P = 0.024), and there was a trend in HDx (0.22 +/- 0.01 U/mL, P = 0.05). APTT post-dialysis in HF-HD (30.5 +/- 0.7 s) was significantly different from that in HDx (28.2 +/- 0.64 s, P = 0.009) and HDF (28.8 +/- 0.73 s, P = 0.009).
Conclusions. AXa activity in HDF was significantly lower than that in HF-HD, possibly because of more losses of LMWH through the dialyser. Given the higher anticoagulant loss in HDF and probably in HDx than in HF-HD, the enoxaparin dose administered may be adjusted according to the dialysis technique.
Filiaciones:
:
Hosp Univ Vinalopo, Nephrol Dept, Elche, Spain
Macias, N:
Hosp Gen Univ Gregorio Maranon, Nephrol Dept, Madrid, Spain
Vega, A:
Hosp Gen Univ Gregorio Maranon, Nephrol Dept, Madrid, Spain
Abad, S:
Hosp Gen Univ Gregorio Maranon, Nephrol Dept, Madrid, Spain
Linares, T:
Hosp Gen Univ Gregorio Maranon, Nephrol Dept, Madrid, Spain
Aragoncillo, I:
Hosp Gen Univ Gregorio Maranon, Nephrol Dept, Madrid, Spain
:
Hosp Univ Elche, Nephrol Dept, Elche, Spain
Pascual, C:
Hosp Gen Univ Gregorio Maranon, Hematol Dept, Madrid, Spain
Goicoechea, M:
Hosp Gen Univ Gregorio Maranon, Nephrol Dept, Madrid, Spain
Lopez-Gomez, J:
Hosp Gen Univ Gregorio Maranon, Nephrol Dept, Madrid, Spain
Green Published, gold
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