Al-Saran Khalid A, Sabry Alaa, Taha Moammer, Ghafour Mamdouh Abdul, Al Fawzan Fawzan
Prince Salman Center for Kidney Disease, Riyadh, Saudi Arabia.
Saudi J Kidney Dis Transpl. 2010 Jan;21(1):43-9.
Low-molecular-weight heparin (LMWH) has been suggested as providing safe, efficient, convenient, and possibly more cost-effective anticoagulation for hemodialysis (HD) than unfractionated heparin (UFH) with a single bolus dose at the start of hemodialysis effectively prevents clot formation in the dialyzer and bubble trap with fewer side-effects and possible benefits on uremic dyslipidemia. In this study, we compared the safety, clinical efficacy, and cost effectiveness of tinzaparin sodium (Innohep) with unfractionated heparin (UFH) in 23 chronic HD patients; their extracorporeal anticoagulant protocol consisted of UFH was switched to tinzaparin for a period of 6 months. Clinical clotting (grade 1-4) was evaluated by visual inspection after blood draining of the air trap every hour and the dialyzer after each session. Anticoagulation with tinzaparin sodium resulted in less frequent dialyzer and air-trap clotting compared to UFH (P= 001 and 0.04 respectively). Over 24 weeks, we observed no alteration in the serum lipid profile of the patients. There was a statistically significant improvement in the dialysis single pool Kt/V after 6 months of tinzaparin use (1.40 + or - 0.28 for tinzaparin versus 1.23 + or - 0.28 for heparin) without any modification in the hemodialysis prescription. The total cost for 24 weeks use of tinzaparin sodium was 23% more expensive compared to that for UFH. We conclude that a single bolus of Tinzaparin sodium injection at the start of the dialysis session was more effective and convenient in our patients than UFH, but at a higher total cost. Furthermore, at least on the short term, there was no observed benefit on the lipid profile.
低分子量肝素（LMWH）被认为比普通肝素（UFH）能为血液透析（HD）提供更安全、高效、便捷且可能更具成本效益的抗凝作用。在血液透析开始时单次推注剂量的低分子量肝素能有效防止透析器和气泡捕集器中形成血凝块，副作用更少，且可能对尿毒症血脂异常有益。在本研究中，我们比较了23例慢性血液透析患者使用替扎肝素钠（Innohep）与普通肝素（UFH）的安全性、临床疗效和成本效益；他们的体外抗凝方案是将普通肝素换成替扎肝素，为期6个月。每小时排空空气捕集器中的血液后以及每次透析结束后通过目视检查评估临床凝血情况（1 - 4级）。与普通肝素相比，替扎肝素钠抗凝时透析器和空气捕集器凝血的频率更低（分别为P = 0.01和0.04）。在24周内，我们观察到患者的血清脂质谱没有变化。使用替扎肝素6个月后，透析单池Kt/V有统计学意义的改善（替扎肝素为1.40±0.28，肝素为1.23±0.28），且血液透析处方未作任何修改。使用24周替扎肝素钠的总成本比普通肝素高23%。我们得出结论，在透析开始时单次推注替扎肝素钠注射液对我们的患者来说比普通肝素更有效、更便捷，但总成本更高。此外，至少在短期内，未观察到对脂质谱有有益影响。
