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Abstract: PO0935

Single-Bolus Tinzaparin Anticoagulation in Extended Hemodialysis Sessions: A Feasibility Study

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Harvey, Benoît, Universite de Montreal, Montreal, Quebec, Canada
  • Leclerc, Simon, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
  • Elftouh, Naoual, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
  • Vallee, Michel, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
  • Laurin, Louis-Philippe, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
  • Nadeau-Fredette, Annie-Claire, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
Background

Few studies have assessed the use of low-molecular weight heparins for anticoagulation during extended hemodialysis (HD) sessions. This study aimed to evaluate the safety and efficacy of tinzaparin for anticoagulation of the extracorporeal circuit and dialyzer in extended, 8-hour, sessions.

Methods

This single-center study included all patients who underwent a single in-centre 8-hour session as part of their nocturnal home HD training between 2009 and 2020. Tinzaparin was delivered as a single bolus injection at time 0 with dosing based on the patient’s weight and doubling of standard 4-hour session dose. Tinzaparin safety was assessed via anti-Xa measured at 15-, 30-min, 1-, 2-, 4-, 6-, 8-hour. Efficacy was examined via visual observations (score 1-4) of the dialyzer and venous bubble trap at the end of dialysis. Predictors of clotting levels were assessed in exploratory logistic regressions.

Results

Forty-seven patients were included: age 45 ±14 yrs, 28% women, 9% on warfarin, 42% on antiplatelets, BMI 29±7 kg/m2, hemoglobin 114±15 g/L and platelet 203±61 109/L. Mean tinzaparin dose was 107 ± 20 IU/kg. Anti-Xa levels peaked at 15-min with 1.3 ± 04 IU/mL and progressively declined reaching 0.9 ± 0.3 IU/mL at 1-hour, 0.4 ± 0.21 IU/mL a 4-hour, and 0.15 ± 0.15 IU/mL after 8-hour. Figure1 After the 8-hour session, none of the patients had severe clotting of their dialyzer or venous chamber. Moderate blood clotting was observed in the dialyzer of 6 (20%) patients and in the venous chamber of 22 (61%) patients. Tinzaparin dose was increased for 27 (81%) patients with a mean maintenance dose of 123 ± 28 IU/kg. None of the main baseline characteristics (including tinzaparin dose per kg) were associated with clotting scores.

Conclusion

This study shows that anti-Xa levels stabilize rapidly after administration on tinzaparin for 8-hour HD. Administration of a single bolus tinzaparin at the start of an eight-hour dialysis session appeared safe and effective, although dose adjustment may be required.