Key result
Low-dose heparin combined with urokinase significantly reduced the required heparin dose and resulted in shorter post-dialysis APTT (97.75 vs 140.16 s, P=0.002) compared to heparin alone.
Why the study?
Does low-dose heparin combined with urokinase reduce the required heparin dose and improve coagulation parameters in patients with hypercoagulable states during hemodialysis?
Observational
Does low-dose heparin combined with urokinase reduce the required heparin dose and improve coagulation parameters in patients with hypercoagulable states during hemodialysis?
Absolute Event Rate: 97.75% vs 140.16%
p-value: p=0.002
The addition of urokinase to heparin during hemodialysis in patients with hypercoagulable states safely reduces the required heparin dose and improves post-dialysis coagulation parameters.
May allow lower heparin dosing in hypercoagulable hemodialysis; hypothesis-generating and requires randomized confirmation before practice change.
Heparin is routinely administered at high doses during hemodialysis to patients with hypercoagulable states. This study aimed to evaluate the safety and efficacy of low-dose heparin in combination with urokinase in this patient population. The presence of a hypercoagulable state was confirmed by thromboelastography. Doses of heparin and urokinase were adjusted based on activated partial thromboplastin time (APTT). Clotting in the extracorporeal circuit was evaluated by a semi-quantitative index. Prothrombin time (PT) and APTT were measured before, during and after dialysis. Kt/V(urea) was used to assess the efficacy of dialysis. D-dimer levels were measured 2 h after the start of hemodialysis. Hemodialysis data with heparin administered alone prior to dialysis were used as control in the present study. With urokinase treatment, the initial dose of heparin was reduced by 45.0 ± 11.4% during hemodialysis and the maintenance dose by 46.8 ± 12.8% compared with heparin alone. No side effects due to urokinase were observed. Bleeding events were rare. Post-dialysis PT (12.99 ± 1.41 vs. 15.22 ± 3.12 s, p = 0.02) and APTT (97.75 ± 43.62 vs. 140.16 ± 30.12 s, p = 0.002) with urokinase plus heparin were significantly shorter than with heparin alone. Finally, during dialysis, D-dimer levels were significantly higher with heparin alone (0.21 ± 0.11 mg/L) than with heparin and urokinase (0.169 ± 0.122 mg/L, p = 0.017). In conclusion, urokinase significantly reduced the dose of heparin required during hemodialysis without any side effects in patients with hypercoagulable states during hemodialysis.
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Ren et al. (2015) conducted an observational in Hypercoagulable states during hemodialysis. Low-dose heparin in combination with urokinase vs. Heparin administered alone prior to dialysis was evaluated on Post-dialysis activated partial thromboplastin time (APTT) (p=0.002). Low-dose heparin combined with urokinase significantly reduced the required heparin dose and resulted in shorter post-dialysis APTT (97.75 vs 140.16 s, P=0.002) compared to heparin alone.
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