engleski

EFFICACY OF LOW DOSES OF NADROPARINE IN HAEMODYALISED PATIENTS

INTRODUCTION AND AIMS: Patients receiving chronic haemodialysis (HD) for end-stage renal disease (ESRD) have high risk of active bleeding. The use of systemic anticoagulation with heparin during HD can cause serious problems. The aim of this prospective study was to define lower than recommended single bolus dose of low molecular weight heparin (LMWH) nadroparine for safe and effective HD in ESRD patients. METHODS: Forty patients (18 females, 22 males) mean age 64, 93 12, 34 years (range 36-84) undergoing intermittent HD for 61, 63 53, 97 months (range 5-196) were included in this 12-weeks long study. Among participants there were 20 diabetics. The lowest recommended bolus doses of 50 IU/kg were decreased by 25% after initial 4 weeks, and further decreased by 25% after 4 weeks. The period of maintance for 50% lower doses of nadroparine were 4 weeks. We investigated four dialysis sessions. Levels of anti-Xa were measured at the end of HD session. The bleeding time from arterial and venous puncture site were also measured. The safety was assessed by noting any bleeding episodes (minor or major). RESULTS: The starting doses of nadroparine was 3847, 50 1359, 77 IU/HD, second 2932, 90 1024, 25 IU/HD, third 2326, 28 1162, 46 IU/HD, and forth was 2475, 00 1159, 09 IU/HD. There were differences in means of anti-Xa activity measured et the end of dialysis (Table 1) among four investigated dialysis sessions during the study period (F=48, 69 ; p<0, 001) (Figure 1). Bleeding time et the end of the first and last dialysis session were compared, and no differences in arterial (314, 31247, 00 vs. 237, 03 174, 54 ; p=0, 108) and venous (207, 21 116, 47 vs. 228, 62 206, 29 ; p=0, 636) puncture sites were found. There was only one (major) bleeding episode. CONCLUSIONS: This trial demonstrated that decreased bolus doses of nadroparine by 35, 67% (mean 1372, 5 IU/HD) in patients on HD were sufficient for safe and effective HD. The bleeding time from venous and arterial puncture site did not differ during the study. An index of anti-Xa at the end of HD was a good marker for safe decreasing dose of nadroparine. Further investigations with higher number of participants will show if this anticoagulant regime is mandatory for HD.

haemodialysis: anticoagulation; complications; outcome; technique

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