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Hemodialysis International.... Apr 2020Low-molecular weight heparin, such as dalteparin, is an alternative anticoagulation method in conventional hemodialysis (HD). However, there are limited studies on its...
INTRODUCTION
Low-molecular weight heparin, such as dalteparin, is an alternative anticoagulation method in conventional hemodialysis (HD). However, there are limited studies on its use in quotidian and nocturnal HD. We assessed the optimal dose, treatment efficacy, and patient safety of dalteparin in quotidian and nocturnal HD populations.
METHODS
This study included 10 quotidian (7 in-center and 3 home) and 8 nocturnal home HD patients. Dalteparin was initiated and titrated based on clotting score in these patients. Trough anti-Xa levels were measured. The dalteparin dose, the dialyzer and HD circuit clotting scores, and bleeding episodes were recorded at 4 weeks. Patients who continued dalteparin were followed to 12 months.
FINDINGS
For the 10 quotidian HD patients, the median dalteparin dose was 1875 units [1250, 2500] after 4 weeks. For nocturnal HD patients, five of the eight patients switched back to heparin due to high clotting scores while on dalteparin within 4 weeks. However, three patients continued on dalteparin at 4 weeks. After 12 months, one maintained on 5000 units and the other two maintained on 7500 units of dalteparin. All the clotting scores at month 12 were ≤2. One patient died due to an unrelated cause. For all patients who continued on dalteparin, only 9% of the HD treatments had circuit clotting score >2 after reaching stable dose. All trough anti-Xa levels were <0.1 IU/mL. There were no episodes of bleeding. Fistula compression times were not increased.
DISCUSSION
This small pilot study suggests that dalteparin can be used effectively and relatively safety in quotidian HD. However, its use in nocturnal HD was only successful in a small proportion of patients. Alternative methods, including second dalteparin bolus after 4 hours of HD treatment, should be assessed for efficacy and practicality.
Topics: Anticoagulants; Dalteparin; Female; Hemodialysis, Home; Humans; Kidney Failure, Chronic; Male; Middle Aged; Pilot Projects; Prospective Studies; Renal Dialysis
PubMed: 31804773
DOI: 10.1111/hdi.12805 -
Pediatric Nephrology (Berlin, Germany) Dec 2018The aim of this study was to investigate whether dalteparin is a safe and effective anticoagulant for paediatric home haemodialysis (HD) and to assess the determinants... (Observational Study)
Observational Study
BACKGROUND
The aim of this study was to investigate whether dalteparin is a safe and effective anticoagulant for paediatric home haemodialysis (HD) and to assess the determinants of dosing.
METHODS
Data were collected for all children (< 18 years) undergoing home HD from 2011 to 2017 at one large paediatric nephrology centre in the UK. All children had anticoagulation with dalteparin sodium according to a standardised protocol. Dalteparin safety was assessed by monitoring for accumulation, adequate clearance of dalteparin and adverse events. Dalteparin efficacy was assessed through monitoring for clot formation in dialysis circuits. Potential determinants of dalteparin dosing were assessed.
RESULTS
Eighteen children were included, their median age at start was 12 years, and 50% were male. Eighty-three percent of children had four home HD sessions each week, with a median total dialysis hours of 20 h/week. Thirty-three percent of children had nocturnal home HD. Median dalteparin dose at 12-month follow-up was 40 IU/kg (range 8-142 IU/kg). Factors associated with higher dalteparin dosing requirements included a younger age of the child (p < 0.01), a lower blood flow rate (p < 0.01) and the use of a central venous line for dialysis access (p = 0.038). No children had evidence of bioaccumulation of dalteparin or inadequate clearance. No significant bleeding or adverse events were reported.
CONCLUSIONS
Dalteparin is a safe and effective anticoagulant when used for paediatric home HD. In this study, there was no evidence of bioaccumulation or significant adverse events. Further research is required to directly compare dalteparin with unfractionated heparin (UFH) and evaluate anticoagulant choice for paediatric home HD.
Topics: Adolescent; Age Factors; Anticoagulants; Blood Coagulation; Child; Child, Preschool; Dalteparin; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Hemodialysis, Home; Hemorrhage; Humans; Kidney Failure, Chronic; Male; Retrospective Studies; Thrombosis; United Kingdom
PubMed: 30173320
DOI: 10.1007/s00467-018-4032-1 -
Connecticut Medicine Jan 2009
Review
Topics: Acute Coronary Syndrome; Anticoagulants; Dalteparin; Fibrinolytic Agents; Formularies, Hospital as Topic; Venous Thromboembolism
PubMed: 19248570
DOI: No ID Found -
Lancet (London, England) Feb 2015
Topics: Dalteparin; Female; Fibrinolytic Agents; Humans; Pregnancy; Pregnancy Complications, Cardiovascular; Thrombophilia
PubMed: 25706215
DOI: 10.1016/S0140-6736(15)60286-0 -
Lancet (London, England) Feb 2015
Topics: Dalteparin; Female; Fibrinolytic Agents; Humans; Pregnancy; Pregnancy Complications, Cardiovascular; Thrombophilia
PubMed: 25706212
DOI: 10.1016/S0140-6736(15)60284-7 -
The Annals of Pharmacotherapy Feb 2001
Topics: Animals; Anticoagulants; Dalteparin; Female; Hemorrhage; Humans; Retroperitoneal Space; Ultrasonography
PubMed: 11215849
DOI: 10.1345/aph.10212 -
Clinical and Applied... Jun 2012Dalteparin and enoxaparin are recommended as thromboprophylaxis for at least 10 days in patients undergoing abdominal surgery (AS) or hospitalized patients with acute... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Dalteparin and enoxaparin are recommended as thromboprophylaxis for at least 10 days in patients undergoing abdominal surgery (AS) or hospitalized patients with acute medical illnesses. Even though both agents have proven clinical effectiveness through randomized trials, there have been no head-to-head studies. In this evaluation, indirect statistical techniques were used to compare safety and efficacy between dalteparin and enoxaparin in these 2 high-risk patient populations.
METHODS
A literature search was conducted from January 1980 to November 2010 for randomized trials evaluating dalteparin or enoxaparin prophylaxis following AS or in hospitalized patients. Binary outcomes for safety and efficacy were statistically pooled using fixed or random effects models in cases of significant heterogeneity. In trials where a common control was used (eg, unfractionated heparin [UH]), indirect statistical comparisons between dalteparin and enoxaparin were performed using meta-regression analysis with active drug as the primary independent variable.
RESULTS
The meta-analysis in AS patients showed that enoxaparin or dalteparin had comparable efficacy to UH in terms of venous thromboembolic events (VTEs; relative risk reduction [RR] = 0.87, P = .46). The indirect statistical comparison was unable to find significant differences between enoxaparin and dalteparin in terms of risk for VTE (P = .84), major bleeding (P = .38), heparin-induced thrombocytopenia ([HIT]; P = .084), or death (P = .97). In acutely ill medical patients, treatment with enoxaparin or dalteparin had a 52% VTE risk reduction compared to placebo (RR = 0.48, P < .001). The indirect comparison was also unable to find significant differences between enoxaparin and dalteparin in terms of VTEs (P = .15), major bleeds (P = .39), HIT (P = .48), and death (P = .41).
CONCLUSIONS
The findings suggest comparable safety and efficacy between dalteparin and enoxaparin in AS and in acutely ill medical patients.
Topics: Anticoagulants; Dalteparin; Enoxaparin; Female; Humans; Male; Randomized Controlled Trials as Topic; Risk Factors; Venous Thromboembolism
PubMed: 22387576
DOI: 10.1177/1076029611426869 -
The New England Journal of Medicine Jul 2011
Topics: Anticoagulants; Critical Illness; Dalteparin; Heparin; Humans; Thrombocytopenia; Venous Thrombosis
PubMed: 21751919
DOI: 10.1056/NEJMc1105423 -
Vascular Health and Risk Management 2008Cancer is a major risk factor for the development of venous thromboembolism (VTE). Conventional anticoagulant therapy with a vitamin K antagonist is more problematic in... (Review)
Review
Cancer is a major risk factor for the development of venous thromboembolism (VTE). Conventional anticoagulant therapy with a vitamin K antagonist is more problematic in cancer patients due to an increased risk of recurrent VTE, and an increased risk of anticoagulant-related bleeding. In recent years, there has been a shift toward treating cancer patients with VTE with extended duration dalteparin. Dalteparin, a low-molecular-weight heparin, has been shown to be more effective, and as safe as conventional anticoagulant therapy, in cancer patients with VTE. This paper will (a) review the relationship between cancer and VTE, and (b) provide an overview of the role of dalteparin in the management of VTE in patients with cancer.
Topics: Anticoagulants; Dalteparin; Drug Costs; Humans; Neoplasms; Quality of Life; Risk Factors; Treatment Outcome; Venous Thromboembolism
PubMed: 18561503
DOI: 10.2147/vhrm.s2132 -
Nephron. Clinical Practice 2013Usually, the appropriate dosage of low-molecular-weight heparin during haemodialysis is empirically based on the clinical effect. We studied the pharmacokinetics of... (Observational Study)
Observational Study
BACKGROUND/AIMS
Usually, the appropriate dosage of low-molecular-weight heparin during haemodialysis is empirically based on the clinical effect. We studied the pharmacokinetics of dalteparin during standard haemodialysis in different groups of patients to assess the added value of measuring the anti-Xa activity for dose monitoring and adjustments.
METHODS
The pharmacokinetics of intravenously administered dalteparin during haemodialysis was studied in 9 patients during 27 haemodialysis sessions. Six patients received a single bolus dose of dalteparin (group 1), and 3 patients received a higher initial bolus dose of dalteparin followed by a second bolus dose after 2 h (group 2). The clinical effect was evaluated by visual inspection for clot formation in the extracorporeal circuit.
RESULTS
The pharmacokinetic curve suggests a zero-order process of elimination. The mean decrease in anti-Xa activity (slope) was comparable in all patients. The mean anti-Xa activity at the end of haemodialysis (Clast) was 0.15 IU/ml in group 1 and 0.60 IU/ml in group 2.
CONCLUSION
We conclude that measuring anti-Xa activity can be used to monitor the elimination of dalteparin during haemodialysis and is highly reproducible.
Topics: Aged; Aged, 80 and over; Anticoagulants; Dalteparin; Female; Follow-Up Studies; Humans; Injections, Intravenous; Kidney Failure, Chronic; Male; Middle Aged; Renal Dialysis
PubMed: 24401673
DOI: 10.1159/000356384