PMID- 12808176
OWN - NLM
STAT- MEDLINE
DCOM- 20031210
LR  - 20220410
IS  - 0931-0509 (Print)
IS  - 0931-0509 (Linking)
VI  - 18
IP  - 7
DP  - 2003 Jul
TI  - Different effects of enoxaparin and unfractionated heparin on extrinsic blood 
      coagulation during haemodialysis: a prospective study.
PG  - 1376-82
AB  - BACKGROUND: Heparin inhibits prothrombotic tissue factor (TF) and releases its 
      inhibitor, tissue factor pathway inhibitor (TFPI), from the endothelium, but 
      repeated administration of heparin depletes vascular stores of TFPI. We studied 
      the anticoagulant effects of unfractionated heparin (UFH) vs low-molecular-weight 
      enoxaparin-used for thrice-weekly maintenance haemodialysis (HD)-on plasma levels 
      of total TF and TFPI and on those of an activated coagulation marker prothrombin 
      fragment 1+2 (PF 1+2). METHODS: Twenty-five patients dialysed using a single 
      injection of enoxaparin (at a mean dose of 0.68 mg/kg) were randomly assigned to 
      either receive UFH administered as a mean bolus of 42.1 IU/kg and continuous 
      infusion of 57.8 IU/kg (n=12) or to be maintained on enoxaparin (n=13), and were 
      followed prospectively for 12 weeks. Plasma immunoreactive TF, TFPI and PF 1+2 
      were measured at the start and after 10 and 180 min of HD, and compared with 
      values in 15 healthy controls. RESULTS: Pre-dialysis TF, TFPI and PF 1+2 were 
      higher than normal (all P<0.0001). TF and PF 1+2 did not change, while TFPI 
      levels, compared with baseline, increased at each interval in 
      enoxaparin-anticoagulated HD patients (all P<0.0001). TFPI increments correlated 
      inversely with pre-dialysis TFPI (both P<0.0007). In patients switched to UFH, TF 
      levels remained unchanged compared with pre-randomization values, TFPI increased 
      at each interval of HD sessions (all P<0.035) and PF 1+2 increased pre-dialysis 
      (P=0.015). The over-dialysis effects of UFH resembled those of enoxaparin. In 
      contrast, baseline TFPI and its 10-min rise correlated inversely with the UFH 
      loading dose (both P<0.040). Pre-dialysis PF 1+2 was inversely associated with 
      TFPI increments (both P<0.034), and directly with pre-dialysis TFPI (P=0.018) and 
      the UFH loading dose (P=0.045). CONCLUSIONS: Depletion of heparin-releasable 
      stores of TFPI is an untoward effect of repeated anticoagulation during 
      maintenance HD therapy. The traditional UFH regimen is more prothrombotic than 
      single enoxaparin injections, with high loading doses of UFH being involved in 
      TFPI exhaustion and subsequent hypercoagulability.
FAU - Naumnik, Beata
AU  - Naumnik B
AD  - Department of Nephrology and Internal Medicine, Medical Academy, Bialystok, 
      Poland.
FAU - Borawski, Jacek
AU  - Borawski J
FAU - Mysliwiec, Michal
AU  - Mysliwiec M
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Nephrol Dial Transplant
JT  - Nephrology, dialysis, transplantation : official publication of the European 
      Dialysis and Transplant Association - European Renal Association
JID - 8706402
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Hemostatics)
RN  - 0 (Lipoproteins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Protein Precursors)
RN  - 0 (lipoprotein-associated coagulation inhibitor)
RN  - 72270-84-9 (prothrombin fragment 1)
RN  - 78768-79-3 (prothrombin fragment 2)
RN  - 9001-26-7 (Prothrombin)
RN  - 9005-49-6 (Heparin)
RN  - 9035-58-9 (Thromboplastin)
SB  - IM
CIN - Nephrol Dial Transplant. 2004 Mar;19(3):749; author reply 749-50. PMID: 14767045
MH  - Aged
MH  - Anticoagulants/*pharmacology
MH  - Blood Coagulation/*drug effects
MH  - Enoxaparin/*pharmacology
MH  - Female
MH  - Fibrinolytic Agents/blood
MH  - Follow-Up Studies
MH  - Hemostatics/blood
MH  - Heparin/*pharmacology
MH  - Humans
MH  - Kidney Failure, Chronic/blood/*therapy
MH  - Lipoproteins/blood/drug effects
MH  - Male
MH  - Middle Aged
MH  - Peptide Fragments/blood/drug effects
MH  - Prospective Studies
MH  - Protein Precursors/blood/drug effects
MH  - Prothrombin/analysis/drug effects
MH  - *Renal Dialysis
MH  - Thromboplastin/analysis/drug effects
MH  - Time Factors
EDAT- 2003/06/17 05:00
MHDA- 2003/12/12 05:00
CRDT- 2003/06/17 05:00
PHST- 2003/06/17 05:00 [pubmed]
PHST- 2003/12/12 05:00 [medline]
PHST- 2003/06/17 05:00 [entrez]
AID - 10.1093/ndt/gfg058 [doi]
PST - ppublish
SO  - Nephrol Dial Transplant. 2003 Jul;18(7):1376-82. doi: 10.1093/ndt/gfg058.