Low-molecular-weight heparin (LMWH): influence on blood lipids in patients on chronic haemodialysis.

A low-molecular-weight heparin (LMWH) has been compared to conventional heparin in haemodialysis in a 12-month study. In a group of 22 patients who had been on chronic haemodialysis for longer than 12 months, the conventional, unfractionated heparin was replaced by a low-molecular-weight analogue (LMWH) (Fragmin, Kabi-Pharmacia Erlangen) for 6 months. Baseline values of lipoprotein profile prior to the intervention were compared with results obtained after 2, 4 and 6 months of LMWH. Control values were obtained 3 and 6 months after switching back to conventional heparin. During the LMWH treatment total cholesterol decreased significantly. This coincided with a significant decrease in LDL cholesterol and a minor decrease in total HDL cholesterol. There was no noticeable change in the HDL cholesterol subfractions. The decrease of LDL and HDL was accompanied by a distinct and continuous decrease of apolipoprotein B throughout the LMWH period while the apolipoprotein A1 declined during the first 2 months and then stabilized at this lower value. Triglycerides increased significantly during the first 2 months and then rebounded to the initial values by the end of the LMWH treatment period. After switching back again to conventional heparin the lipoprotein parameters returned to the starting values. We conclude that the long-term use of low-molecular-weight heparin instead of conventional heparin for anticoagulation during dialysis may contribute to a reduction of the cardiovascular risk factors of haemodialysis patients.