Enoxaparin, nadroparin, and dalteparin significantly increased TFPI levels compared to baseline during hemodialysis (P < 10(-4)), with enoxaparin providing the most potent short-term stimulus.
RCT (n=21)
Crossover (Latin-square design)
Do different low-molecular-weight heparins (enoxaparin, nadroparin, dalteparin) have varying effects on plasma TFPI and hemostatic factors during hemodialysis in maintenance HD patients?
Enoxaparin provides the most potent short-term stimulus for endothelial TFPI release during hemodialysis compared to nadroparin and dalteparin, though long-term baseline levels remain unaffected.
p-value: p=< 10(-4)
BACKGROUND: Low-molecular-weight heparins (LMWHs) are an alternative to unfractionated heparin (UFH) for anticoagulation during hemodialysis (HD). We performed a prospective randomized crossover study of the effect of enoxaparin, nadroparin, and dalteparin on some hemostatic factors, including tissue factor pathway inhibitor (TFPI), in patients with maintenance HD. METHODS: Plasma levels (immunoassays) of total TFPI, platelet-derived growth factor-AB (PDGF-AB), and prothrombin fragment 1 + 2 (PF 1 + 2) were evaluated pre-HD, after 10 (T10) and 180 (T180) minutes of HD in 21 patients, who completed a 3-period (for 2 months each) crossover study in 6 groups (Latin-square design). RESULTS: The baseline TFPI, PDGF-AB, and PF 1 + 2 levels were comparable under all LMWH treatments. Tissue factor pathway inhibitor levels, compared with the baseline, significantly increased (all P < 10(-4)), whereas PDGF-AB levels remained stable at each interval during enoxaparin, nadroparin, and dalteparin anticoagulated HD. Interestingly, TFPI increment at T10 was the highest, dose-dependent, and accompanied by PF 1 + 2 decrease under enoxaparin administration. CONCLUSION: The switch from enoxaparin to nadroparin and dalteparin used as anticoagulants had no long-term effect on the baseline total TFPI and PF 1 + 2 levels in chronically HD patients. Only short-term, overdialytic differences were noticed, indicating a single bolus of enoxaparin (0.75 mg/kg) as the most potent stimulus for endothelial TFPI.
Naumnik et al. (Tue,) conducted a rct in Maintenance hemodialysis (n=21). Enoxaparin, nadroparin, and dalteparin vs. Active comparators (crossover design) was evaluated on Plasma levels of total TFPI, PDGF-AB, and PF 1 + 2 (p=< 10(-4)). Enoxaparin, nadroparin, and dalteparin significantly increased TFPI levels compared to baseline during hemodialysis (P < 10(-4)), with enoxaparin providing the most potent short-term stimulus.
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