Abstract:
:The optimal anticoagulation regimen for hemodialysis (HD) in patients with heparin-induced thrombocytopenia (HIT) has not been defined. Hemodiafiltration (HDF) adds a large convective component to HD, thereby changing the pharmacokinetics of most anticoagulants. Data on coagulation regimens for HDF are scant. We therefore aimed to study the feasibility, effectiveness, tolerability, and pharmacokinetics of fondaparinux anticoagulation in HDF. This was a prospective observational dose-finding study. Patients were started on fondaparinux at a dose of 0.05 mg/kg postdialysis body weight. Per protocol dose escalation was performed when significant clotting was observed and reduced when the anti-Xa activity postdialysis exceeded 0.4 IU/mL. Dose adjustments were made by steps of 0.01 mg/kg postdialysis weight. Anti-Xa activity was measured using a chromogenic method calibrated with low-molecular-weight heparin and validated against fondaparinux-calibrated anti-Xa activity. Four patients with HIT were followed for 160 sessions in total. At the end of the dose titration study, three patients ended at a maintenance dose of 0.03 mg/kg and one patient at 0.04 mg/kg of fondaparinux. Significant bleeding attributable to fondaparinux did not occur. The occurrence of clotting increased parallel to the reduction of fondaparinux dose, from 0/53 and 0/15 sessions at the higher doses (0.04 and 0.05 mg/kg) to 3/75 (4%) at 0.03 mg/kg and 1/17 (6%) at 0.02 mg/kg. Fondaparinux may be safely used and provides adequate anticoagulation for HDF in patients with HIT. We recommend to adjust dosage of fondaparinux to body weight and to initiate therapy at a dose of 0.03 mg/kg to prevent accumulation. Dose titration can be achieved by targeting postdialysis anti-Xa activity.
journal_name
Artif Organsjournal_title
Artificial organsauthors
Mahieu E,Claes K,Jacquemin M,Evenepoel P,Op De Beek K,Bogaert AM,Kuypers D,Verhamme P,Meijers Bdoi
10.1111/aor.12002subject
Has Abstractpub_date
2013-05-01 00:00:00pages
482-7issue
5eissn
0160-564Xissn
1525-1594journal_volume
37pub_type
杂志文章abstract::Using computed tomography (CT)-based preoperative planning software, we can define with good accuracy the position of a cementless hip stem inside the host bone, but previous studies suggest that the pose the surgeon achieves during freehand surgery may differ from the planned one even by some millimeters. Advances in...
journal_title:Artificial organs
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journal_title:Artificial organs
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journal_title:Artificial organs
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journal_title:Artificial organs
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journal_title:Artificial organs
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journal_title:Artificial organs
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journal_title:Artificial organs
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journal_title:Artificial organs
pub_type: 杂志文章
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journal_title:Artificial organs
pub_type: 杂志文章
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journal_title:Artificial organs
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journal_title:Artificial organs
pub_type: 杂志文章
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更新日期:2016-11-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/j.1525-1594.1997.tb00735.x
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journal_title:Artificial organs
pub_type: 临床试验,杂志文章
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/j.1525-1594.1992.tb00558.x
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journal_title:Artificial organs
pub_type: 杂志文章
doi:
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journal_title:Artificial organs
pub_type: 临床试验,杂志文章
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journal_title:Artificial organs
pub_type: 杂志文章
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journal_title:Artificial organs
pub_type: 杂志文章
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journal_title:Artificial organs
pub_type: 临床试验,杂志文章
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journal_title:Artificial organs
pub_type: 杂志文章
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