PMID- 22419236
OWN - NLM
STAT- MEDLINE
DCOM- 20130823
LR  - 20130122
IS  - 1724-6059 (Electronic)
IS  - 1121-8428 (Linking)
VI  - 26
IP  - 1
DP  - 2013 Jan-Feb
TI  - Dermatan sulfate: an alternative to unfractionated heparin for anticoagulation in 
      hemodialysis patients.
PG  - 158-63
LID - 10.5301/jn.5000105 [doi]
AB  - BACKGROUND: Unfractionated heparin (UFH) is the standard anticoagulant in regular 
      dialysis treatments (RDTs), despite the fact that it may induce thrombocytopenia, 
      dyslipidemia, allergy and osteoporosis. Dermatan sulfate (DS) selectively 
      inhibits thrombin, does not inhibit F-Xa and does not interfere with platelets 
      (PLTS). Here we described an original protocol for the use of DS as anticoagulant 
      in RDT and compared its effects with those of UFH. METHODS: In 102 patients, 
      7,254 RDTs were performed using DS for anticoagulation (DS-phase) and 5,707 with 
      UFH (UFH-phase). DS was supplied as initial bolus (80 +/- 12 mg) and continuous 
      infusion (14 +/- 7 mg/hour). With UFH, the initial bolus was 1,475 +/- 141 IU and 
      continuous infusion 576 +/- 349 IU/hour. Activated partial thromboplastin time and 
      its ratio were measured at least monthly, both before (pre-RDT APTT ratio) and 
      after (post-RDT APTT ratio) RDT sessions. With 41 of 102 patients, both DS and 
      UFH doses were not changed during study phases (stable patients). In this subset, 
      the coefficient of variation (CV) of all pre-RDT APTT ratio and post-RDT APTT 
      ratio values was calculated. RESULTS: In DS and UFH phases, post-RDT APTT ratio 
      increased by 61% and 50%, respectively, by comparison with pre-RDT APTT ratio 
      (p<0.001). PLTS count was lower in the UFH than in the DS phase (p<0.01). In 
      stable patients, post-RDT APTT ratio CV was lower in the DS than in the UFH phase 
      (p<0.001), which indicates a more predictable anticoagulant effect of DS compared 
      with UFH. CONCLUSIONS: DS appeared as effective as UFH for anticoagulation in 
      RDT. It can reliably be considered as an alternative approach especially in cases 
      of thrombocytopenia or other adverse effects of UFH.
FAU - Vitale, Corrado
AU  - Vitale C
AD  - Nephrology and Dialysis Unit, Ordine Mauriziano Hospital, Turin, Italy. 
      covitale@libero.it
FAU - Berutti, Silvia
AU  - Berutti S
FAU - Bagnis, Cristiana
AU  - Bagnis C
FAU - Soragna, Giorgio
AU  - Soragna G
FAU - Gabella, Paolo
AU  - Gabella P
FAU - Fruttero, Claudia
AU  - Fruttero C
FAU - Marangella, Martino
AU  - Marangella M
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - Italy
TA  - J Nephrol
JT  - Journal of nephrology
JID - 9012268
RN  - 0 (Anticoagulants)
RN  - 24967-94-0 (Dermatan Sulfate)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Blood Coagulation/drug effects
MH  - Confidence Intervals
MH  - Dermatan Sulfate/*administration & dosage/adverse effects
MH  - Female
MH  - Hemorrhage/chemically induced
MH  - Heparin/*administration & dosage/adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Odds Ratio
MH  - Partial Thromboplastin Time
MH  - Platelet Count
MH  - Renal Dialysis/adverse effects/*methods
MH  - Retrospective Studies
EDAT- 2012/03/16 06:00
MHDA- 2013/08/24 06:00
CRDT- 2012/03/16 06:00
PHST- 2011/12/27 00:00 [accepted]
PHST- 2012/03/16 06:00 [entrez]
PHST- 2012/03/16 06:00 [pubmed]
PHST- 2013/08/24 06:00 [medline]
AID - AA5D7135-C08B-408A-AFBC-7D0B7726694B [pii]
AID - 10.5301/jn.5000105 [doi]
PST - ppublish
SO  - J Nephrol. 2013 Jan-Feb;26(1):158-63. doi: 10.5301/jn.5000105.