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Different effects of enoxaparin and unfractionated heparin on some thrombogenesis markers during hemodialysis: a cross-over study.

Abstract：

BACKGROUND:Unfractionated heparin (UFH) and low molecular weight heparin constitute fundamental anticoagulants during hemodialysis (HD). We aimed to investigate the effect of UFH and enoxaparin on plasma levels of prothrombin fragment 1+2 (PF 1+2) and thrombin/antithrombin complex (TAT) as markers of intravascular thrombogenesis during HD. METHODS:We enrolled 22 chronic HD patients, who were randomly assigned to either iv enoxaparin (n=11) or UFH (n=11) anticoagulation, and followed prospectively for 12 weeks before crossing over to the alternate therapy for further 12 weeks. Plasma levels of PF 1+2 and TAT were measured by immunoassay at the start, at 10 and 180 min of HD session after each period of evaluation. RESULTS:The baseline PF 1+2 and TAT levels were comparable under enoxaparin and UFH treatment. PF 1+2 significantly decreased during both UFH (chi(2) ANOVA=9.82, P=0.007) and enoxaparin (chi(2) ANOVA=29.40, P<10(-6)) anticoagulated HD, while over-HD TAT levels changes differed depending on the type of heparin. The switch from enoxaparin to UFH treatment was connected with a significantly higher PF 1+2 after 10 and 180 min as well as higher TAT concentration after 180 min of HD. Only during enoxaparin anticoagulated HD 34% PF 1+2 decrease and TAT levels after 180 min of HD was closely associated with heparin dosage. CONCLUSION:Single bolus of enoxaparin ensures efficient and convenient anti-thrombotic protection during HD procedure. Enoxaparin mean dose of 0.67 mg/kg, which is generally lower than manufacturer's instructions, can be recommended for over-dialytic regular use.

journal_name

Thromb Res

journal_title

Thrombosis research

authors

Naumnik B,Pawlak K,Myśliwiec M

doi

10.1016/j.thromres.2007.12.014

subject

Has Abstract

pub_date

2009-02-01 00:00:00

pages

631-6

issue

4

eissn

0049-3848

issn

1879-2472

pii

S0049-3848(07)00485-9

journal_volume

123

pub_type

杂志文章,随机对照试验

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