PMID- 26365216
OWN - NLM
STAT- MEDLINE
DCOM- 20180116
LR  - 20220318
IS  - 0301-0430 (Print)
IS  - 0301-0430 (Linking)
VI  - 84
IP  - 5
DP  - 2015 Nov
TI  - Major bleeding in hemodialysis patients using unfractionated or low molecular 
      weight heparin: a single-center study.
PG  - 274-9
LID - 10.5414/CN108624 [doi]
AB  - BACKGROUND: Successful hemodialysis (HD) requires circuit anticoagulation, with 
      either unfractionated heparin (UFH) or low molecular weight heparin (LMWH) - it 
      is not clear if differences in risk or benefit between these agents exist. We 
      report our experience of major bleeding in patients on hemodialysis receiving 
      either LMWH or UFH for anticoagulation of the dialysis circuit. We also examined 
      any effect of anti-platelet agents or oral anticoagulants on bleeding rates. 
      METHODS: An observational, retrospective, single-center study. Bleeding episodes 
      are described using the International Society of Thrombosis and Hemostasis (ISTH) 
      definition of a major bleeding event, and by extending this group to include all 
      bleeds that led to a hospital admission (clinically significant). Incident event 
      rates are reported per 100 at risk patient years, and event-free survival 
      calculated using multivariate analysis by Cox-proportional hazard ratio. RESULTS: 
      We report on 522 patients (792 years of exposure) in the UFHHD cohort and 889 
      patients (1,200 years of exposure) in the LMWH-HD cohort. The incidence of a 
      major bleed was 1.33%, and 1.92% bleeds respectively. The incidences of 
      clinically significant bleeding rates were 3.33% and 3.96% respectively. There 
      was no significant difference in bleed free survival between UFH compared to LMWH 
      (OR 0.904, CI 0.557 a€“ 1.468, p = 0.684). Warfarin or anti-platelet usage did 
      not increase the risk of bleeding when comparing patients not on any 
      anticoagulants. CONCLUSIONS: There is no difference in bleeding rates between 
      hemodialysis patients treated with either UFH or LMWH for anticoagulation of the 
      extracorporeal circuit. We believe that both heparins have similar safety 
      profiles when used for extracorporeal anticoagulation and that bleeding risk 
      should not determine the choice of anticoagulation.
FAU - Nadarajah, Luxme
AU  - Nadarajah L
FAU - Fan, Stanley
AU  - Fan S
FAU - Forbes, Suzanne
AU  - Forbes S
FAU - Ashman, Neil
AU  - Ashman N
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - Germany
TA  - Clin Nephrol
JT  - Clinical nephrology
JID - 0364441
RN  - 0 (Anticoagulants)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 5Q7ZVV76EI (Warfarin)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/*adverse effects/therapeutic use
MH  - Female
MH  - Hemorrhage/*chemically induced/epidemiology
MH  - Heparin/*adverse effects/therapeutic use
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Platelet Aggregation Inhibitors/adverse effects
MH  - Proportional Hazards Models
MH  - Renal Dialysis/*adverse effects
MH  - Retrospective Studies
MH  - Warfarin/adverse effects
EDAT- 2015/09/15 06:00
MHDA- 2018/01/18 06:00
CRDT- 2015/09/15 06:00
PHST- 2015/10/08 00:00 [accepted]
PHST- 2015/09/15 06:00 [entrez]
PHST- 2015/09/15 06:00 [pubmed]
PHST- 2018/01/18 06:00 [medline]
AID - 13719 [pii]
AID - 10.5414/CN108624 [doi]
PST - ppublish
SO  - Clin Nephrol. 2015 Nov;84(5):274-9. doi: 10.5414/CN108624.