Comparison of Enoxaparin, Tinzaparin and Unfractionated Heparin in Hemodialysis Therapy

Chu-Cheng Pai ； Min-Yu Chang ； Yaw-Bin Huang ； Yi-Cheng Lin ； Qing-Yang Chen ； Shih-Yuan Hung

《Acta Nephrologica》 30卷4期 (2016/12) Pp. 187-194

https://doi.org/10.6221/AN.2016015

摘要

BACKGROUND: The most common anticoagulant used for hemodialysis (HD) therapy in Taiwan is unfractionated heparin (UFH). While the use of low molecular weight heparin (LMWH) has been rising in recent decades, the effectiveness and safety of different kinds of LMWH remain controversial. METHOD: Seventy-five chronic HD patients receiving intravenous anticoagulants for HD therapy were assigned to three groups to evaluate the effectiveness and safety of three kinds of heparin, which included enoxaparin, tinzaparin and UFH. Anti-Xa activitiy was measured before the HD therapy session, after the end of the HD therapy session (four hours), and 48 hours after heparin administration. We also recorded incidences of clotting while HD machines were in use during this HD session and bleeding events that occurred in the 48-hour study period. RESULTS: The increase of anti-Xa activity at four hours after heparin administration was significantly higher in the enoxaparin group than in the tinzaparin group (0.43 ± 0.29 vs. 0.20 ± 0.21, for a dosage of 10,000 IU/Kg bodyweight, P = 0.01), but there were no significant differences between the enoxaparin and the UFH groups, or between the tinzaparin group and the UFH groups. Similar results were obtained at 48 hours after heparin administration. For patients in the UFH group, the number of bleeding event incidents was significantly higher than that of both LMWH groups. As for incidences of clotting with HD machines, there was no statistical difference among the three groups. CONCLUSION: Compared to UFH, LMWH may provide a safer anticoagulant effect for HD patients, and enoxaparin seems to be more effective than tinzaparin regarding anti-Xa activity.

關鍵字

anti-Xa activity ； hemodialysis ； heparin ； low molecular weight heparin