Dermatan sulphate: An alternative to unfractionated heparin for anticoagulation in haemodialysis patients

Background: Unfractionated heparin (UFH) is the standard anticoagulant in regular dialysis treatments (RDTs), despite the fact that it may induce thrombocy- topenia, dyslipidemia, allergy and osteoporosis. Der- matan sulfate (DS) selectively inhibits thrombin, does not inhibit F-Xa and does not interfere with platelets (PLTS). Here we described an original protocol for the use of DS as anticoagulant in RDT and compared its effects with those of UFH. Methods: In 102 patients, 7,254 RDTs were performed using DS for anticoagulation (DS-phase) and 5,707 with UFH (UFH-phase). DS was supplied as initial bo- lus (80 ± 12 mg) and continuous infusion (14 ± 7 mg/ hour). With UFH, the initial bolus was 1,475 ± 141 IU and continuous infusion 576 ± 349 IU/hour. Activated par- tial thromboplastin time and its ratio were measured at least monthly, both before (pre-RDT APTT ratio) and af- ter (post-RDT APTT ratio) RDT sessions. With 41of 102 patients, both DS and UFH doses were not changed during study phases (stable patients). In this subset, the coefficient of variation (CV) of all pre-RDT APTT ratio and post-RDT APTT ratio values was calculated. Results: In DS and UFH phases, post-RDT APTT ra- tio increased by 61% and 50%, respectively, by com- parison with pre-RDT APTT ratio (p<0.001). PLTS count was lower in the UFH than in the DS phase (p<0.01). In stable patients, post-RDT APTT ratio CV was lower in the DS than in the UFH phase (p<0.001), which indi- cates a more predictable anticoagulant effect of DS compared with UFH. Conclusions: DS appeared as effective as UFH for an- ticoagulation in RDT. It can reliably be considered as an alternative approach especially in cases of throm- bocytopenia or other adverse effects of UFH.