Assessment of the Adminstration of Low Molecular Weight Heparin for Hemodialysis Anticoagulation in Comparison to Standard Unfractionated Heparin

Abstract

Background and Aim of Study: The use of Low-molecular-weight heparin (LMWH) for hemodialysis anticoagulation has been proposed as effective and safe for hemodialysis (HD) anticoagulation as standard unfractionated heparin (UFH). The aim of our study was to assess the use of LMWH for hemodialysis anticoagulation in comparison to UFH, including hemorrhagic events and clotting of the extracorporeal dialysis circuit and their effect on lipids profile. Methods: This prospective, randomized study conducted on 44 patients (31 males, 13 females; mean age 53.7.9±14.2 years) with end-stage renal disease on regular hemodialysis. The hemodialysis patients were subjected to UFH and followed prospectively for 16 weeks (48 dialyses sessions) and the same patients were subjected to LMWH (enoxaparin sodium; 40 mg) for a further 16 weeks, clotting of the extracorporeal dialysis circuit and hemorrhagic events were evaluated by visual inspection of the air trap, blood lines and dialyzers and the time required for arterio-venous fistula compression. Kt/V was calculated to determine whether UFH or LMWH had any effect on the adequacy of dialysis and lipid profile were measured at the end of each arm of the study to determine whether UFH or LMWH had any effect on the lipid profile levels. Results: The present study showed that, compared with UFH, the effect of LMWH (enoxaparin sodium) on the number of hemorrhagic events (relative risk, 1.3; 95% CI: 0.317 - 5.613; P=1.000) or clotting of the extracorporeal dialysis circuit (relative risk, 0.75; 95% CI: 0.284 - 1.984; P=1.000) was not significant. There was no significant difference in Kt/V between the UFH arm (1.4±0.4) and LMWH (enoxaparin sodium) arm (1.5±1.2; p=0.6). Also there was no significant differences in serum total Cholesterol, LDL, HDL and TGs between the UFH arm and LMWH (enoxaparin sodium arm). Conclusion: LMWH (Enoxaparin sodium) should be considered as effective and safe as unfractionated heparin in hemodialysis anticoagulation. But currently direct costs are about 26% more. So we recommend, the use of UFH for its low cost.