Clinical study on low‐molecular weight heparin infusion as anticoagulation for nocturnal home haemodialysis

摘要

Abstract Aim This study was conducted to evaluate low‐molecular weight heparin (LMWH) as anticoagulation for nocturnal home haemodialysis (NHHD). While its longer half‐life may cause drug accumulation in frequent dialysis, the essential need of a supplementary intra‐dialytic bolus for the sleeping patients also renders LMWH's use impractical. Methods The recruited patients, who were on alternate‐day 8?h haemodialysis, were randomized to receive either nadroparin or unfractionated heparin (UFH) for a week. They underwent crossover to receive the alternate anticoagulant in the next week. A nadroparin infusion regimen was adopted to enhance its practicability, which consisted of a loading dose of 35?IU/kg and a continuous infusion of 10?IU/kg per hour for 6?h. Results A total of 12 NHHD patients were recruited. With nadroparin infusion, the mean anti‐Xa levels at the 2 nd , 4 th , 6 th and 8 th hours of dialysis were 0.46?±?0.11, 0.55?±?0.14, 0.61?±?0.15 and 0.45?±?0.15?IU/mL respectively. Comparing to UFH, which offered satisfactory anticoagulation according to the activated partial thromboplastin time, nadroparin‐treated dialysis achieved similar thrombus scores and dialyser urea/creatinine clearances at the end of haemodialysis. During the post‐dialysis period, one patient demonstrated residual LMWH effect (anti‐Xa level 0.09?IU/mL) on the next day, whereas none had detectable anti‐Xa activities 2 days afterwards upon next dialysis. Conclusions Low‐molecular weight heparin infusion is practical and effective as anticoagulation for NHHD. It can be safely used in an alternate‐day haemodialysis schedule. A close monitoring for LMWH accumulation is recommended if long dialysis is performed daily.