Comparison of Enoxaparin Sodium and Standard Heparin for Hemodialysis Anticoagulation

Background: Low-molecular-weight heparin (LMWH) has been suggested as an effective and safe anticoagulant for hemodialysis. The aim of our study was to investigate the effects of LMWH including minor bleeding, clotting formation in the extracorporeal dialysis circuit and their effect on the lipid profile in comparison with heparin. Methods: This randomized, crossover study with parallel design was conducted in 45 patients who required maintenance hemodialysis due to end-stage renal failure. Four patients with known bleeding disorders, receiving anticoagulant drugs and receiving drugs which could affect heparin activity were excluded. All patients were randomly assigned to receive either enoxaparin sodium (0.7 mg/kg) or standard heparin for a duration of 12 weeks, after which patients were crossed over to another therapy for a further 12 weeks. Enoxaparin sodium was administered 5 minutes before dialysis, injected into the arterial line pre- dialyser and heparin was administered 50 U/kg intravenously into the pre- dialyser arterial line followed by a maintenance dose of 1000 U per hour. Results: The mean age of the study population was of 65.18 (SD = 12.15) years. From these patients 22 (53%) were male and 19 (47%) were female. At the end of the first study phase, minor bleeding in patients receiving enoxaparin with dose of 0.25 mg/kg was significantly decreased in comparison to the patients receiving heparin (P: 0.03), although vascular compression time did not significantly differ between the heparin and enoxaparin groups. At the end of the second study phase, the enoxaparin group showed a significant increase in minor bleeding in comparison with the heparin group (P: 0. 04). In the enoxaparin arm, recurrent blood oozing from puncture sites led to the idea to reduce the dose of enoxaparin. After enoxaparin dose reduction, the frequency of minor bleeding decreased to 10% (from 19% to 10%) (P: 0.01). Vascular compression time was not statistically different in heparin and enoxaparin at the end of study (P: 0.1). There were no significant changes in serum lipids with either anticoagulant neither at the end of the 12th week nor at the end of the 24th week. Conclusions: This study suggests that a single-dose of enoxaparin is an effective and convenient alternative to standard heparin. The recommended dose of this study in Iranian patients is 0.25 mg/kg.