PMID- 28052451 OWN - NLM STAT- MEDLINE DCOM- 20180904 LR - 20180904 IS - 1440-1797 (Electronic) IS - 1320-5358 (Linking) VI - 23 IP - 4 DP - 2018 Apr TI - Clinical study on low-molecular weight heparin infusion as anticoagulation for nocturnal home haemodialysis. PG - 317-322 LID - 10.1111/nep.12995 [doi] AB - 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. CI - (c) 2017 Asian Pacific Society of Nephrology. FAU - Wong, Steve Siu-Man AU - Wong SS AD - Department of Medicine, Alice Ho Miu Ling Nethersole Hospital. FAU - Lau, Wai-Yan AU - Lau WY AD - Department of Medicine, Alice Ho Miu Ling Nethersole Hospital. FAU - Ng, Man-Luen AU - Ng ML AD - Department of Medicine, Alice Ho Miu Ling Nethersole Hospital. FAU - Chan, Shuk-Yin AU - Chan SY AD - Department of Medicine, Alice Ho Miu Ling Nethersole Hospital. FAU - Chan, So-Fan AU - Chan SF AD - Department of Medicine, Alice Ho Miu Ling Nethersole Hospital. FAU - Chan, Ping-Kwan AU - Chan PK AD - Department of Medicine, Alice Ho Miu Ling Nethersole Hospital. FAU - Wan, Ching-Kit AU - Wan CK AD - Department of Medicine, Alice Ho Miu Ling Nethersole Hospital. FAU - Cheng, Yuk-Lun AU - Cheng YL AD - Department of Medicine, Alice Ho Miu Ling Nethersole Hospital. LA - eng PT - Journal Article PT - Randomized Controlled Trial PL - Australia TA - Nephrology (Carlton) JT - Nephrology (Carlton, Vic.) JID - 9615568 RN - 0 (Anticoagulants) RN - 0 (Nadroparin) SB - IM MH - Anticoagulants/*administration & dosage/adverse effects MH - Blood Coagulation/*drug effects MH - Cross-Over Studies MH - Drug Monitoring/methods MH - Female MH - Hemodialysis, Home/adverse effects/*methods MH - Hong Kong MH - Humans MH - Infusions, Parenteral MH - Male MH - Middle Aged MH - Nadroparin/*administration & dosage/adverse effects MH - Partial Thromboplastin Time MH - Time Factors MH - Treatment Outcome OTO - NOTNLM OT - Anticoagulation OT - home haemodialysis OT - low-molecular weight heparin OT - nadroparin OT - unfractionated heparin EDAT- 2017/01/05 06:00 MHDA- 2018/09/05 06:00 CRDT- 2017/01/05 06:00 PHST- 2016/11/22 00:00 [received] PHST- 2016/12/19 00:00 [revised] PHST- 2017/01/03 00:00 [accepted] PHST- 2017/01/05 06:00 [pubmed] PHST- 2018/09/05 06:00 [medline] PHST- 2017/01/05 06:00 [entrez] AID - 10.1111/nep.12995 [doi] PST - ppublish SO - Nephrology (Carlton). 2018 Apr;23(4):317-322. doi: 10.1111/nep.12995.