NDT Advance Access published online on October 18, 2005
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfi203
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
1 Department of Internal Medicine, Rikshospitalet University Hospital, Oslo, Norway
* To whom correspondence should be addressed. Background. Heparin-free haemodialysis (HD) with intermittent saline flushes (ISF) in patients with bleeding risk is widely used. The aim of this study was to investigate if ISF reduce coagulation and clotting in stable patients receiving reduced doses of dalteparin. Methods. Inclusion criteria were stable chronic HD patients Results. Six men and two women were included. In four cases (four different patients), HD was stopped due to a coagulated system, all cases on days with ISF performed. Multiple linear regression analyses with repeated measurements showed that ISF adjusted for dalteparin dose/kg significantly increased mean clot in the bubble trap, estimate (B) = 0.717, P = 0.0001 and also showed that ISF increased PF1+2, B = 0.16, P = 0.001 when adjusted for anti-FXa activity and hours of dialysis, whereas Conclusions. ISF during HD does not alleviate visible clotting or intravascular coagulation activity in stable patients receiving reduced doses of dalteparin and polysulphone dialysers. Whether this applies to unstable patients with increased bleeding risk not receiving any anticoagulation remains to be shown.
Received March 31, 2005
Accepted September 15, 2005
Original Articles
Intermittent saline flushes during haemodialysis do not alleviate coagulation and clot formation in stable patients receiving reduced doses of dalteparin
2 Department of Internal Medicine, Rikshospitalet University Hospital, Oslo, Norway; Laboratory for Renal Physiology, Rikshospitalet University Hospital, Oslo, Norway
3 Institute of Biostatistics, Rikshospitalet University Hospital, Oslo, Norway
4 Research Institute for Internal Medicine, Rikshospitalet University Hospital, Oslo, Norway
5 Dialysis Unit, Rikshospitalet University Hospital, Oslo, Norway
6 Department of Clinical Biochemistry, Rikshospitalet University Hospital, Oslo, Norway
Solbjørg Sagedal, E-mail: solbjorg.sagedal{at}rikshospitalet.no
Abstract 
18 years of age and haemoglobin 11 g/dl. Exclusion criteria were use of warfarin and acetylsalicylic acid. Six HD sessions were evaluated per patient. Dalteparin was given as one bolus dose at start of HD (50% of the conventional dose). In HD number 1, 3 and 5, 100 ml saline solution was flushed through the filter each 30 min. In HD 2, 4 and 6, no ISF were given. Potential clotting in the bubble trap was visually observed each hour and graded on a 4-point scale: 1 = normal, 2 = fibrinous ring, 3 = clot formation and 4 = coagulated system. The dialyser was visually inspected at the end of each session: 1 = normal, 2 = a few blood stripes (affecting less than 5% of the surface fibres), 3 = many blood stripes (more than 5% of the fibres) and 4 = coagulated filter. The coagulation marker PF1+2, the platelet activation marker 
-TG and anti-FXa activity were repeatedly measured during HD.-TG was only borderline increased, B = 0.09, P = 0.055.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  J. Chanard, S. Lavaud, H. Maheut, I. Kazes, F. Vitry, and P. Rieu The clinical evaluation of low-dose heparin in haemodialysis: a prospective study using the heparin-coated AN69 ST membrane Nephrol. Dial. Transplant., June 1, 2008; 23(6): 2003 - 2009. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Chanard, S. Lavaud, and P. Rieu Anticoagulation in haemodialysis. Nephrol. Dial. Transplant., December 1, 2006; 21(12): 3600 - 3601. [Full Text] [PDF]
|
|