Use of the pentasaccharide fondaparinux as an anticoagulant during haemodialysis

Kalicki, Robert; Aregger, Fabienne; Alberio, Lorenzo; Lämmle, Bernhard; Frey, Felix J; Uehlinger, Dominik E (2007). Use of the pentasaccharide fondaparinux as an anticoagulant during haemodialysis. Thrombosis and haemostasis, 98(6), pp. 1200-7. Stuttgart: Schattauer 10.1160/TH07-07-0444

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No data about the use of the pentasaccharide fondaparinux, a highly selective indirect inhibitor of factor Xa, in patients treated with haemodialysis are available. Therefore, we investigated the pharmacokinetics and -dynamics of fondaparinux in 12 patients during haemodialysis. The anti-Xa activity (expressed as fondaparinux equivalent) was monitored, a semiquantitative clotting scale (SQCS) ranging from 0 (no visible traces of coagula) to 3 (complete clotting of the dialysis circuit) was applied, and the digital compression time necessary to achieve haemostasis at the puncture site was determined. After an initial period, when the regular heparin dose was replaced once weekly by fondaparinux, 0.05 mg/kg, the pentasaccharide was administered for nine consecutive haemodialysis sessions. Peak anti-Xa activity increased from 0.61 +/- 0.14 microg/l after the first dose to 0.89 +/- 0.24 microg/l after dose 9 (P < 0.001), whereas predialysis anti-Xa activity steadily rose to 0.32 +/- 0.09 microg/l (P < 0.001). A sufficient but slightly less effective anticoagulation with a mean SQCS of 1.19 +/- 0.71 (n = 121) was obtained by fondaparinux as compared with 0.65 +/- 0.58 (n = 60, P < 0.005) by 4,825 +/- 1,703 U of unfractionated heparin. Mean digital compression time rose slightly during fondaparinux from 23.7 +/- 7.4 minutes to 24.8 +/- 7.5 minutes (P < 0.05) and, more important, six of the 12 patients reported minor bleeding problems during the interdialytic interval. Thus, fondaparinux can be used to prevent circuit clotting during haemodialysis; however, accumulation results in an interdialytic increase of anti-Xa activity. Therefore, fondaparinux should be reserved for patients requiring systemic anticoagulation on the days off dialysis.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Nephrology and Hypertension 04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Haematology and Central Haematological Laboratory
UniBE Contributor:	Kalicki, Robert, Aregger, Fabienne, Alberio, Lorenzo, Lämmle, Bernhard, Frey, Felix (B), Uehlinger, Dominik
Subjects:	600 Technology > 610 Medicine & health
ISSN:	0340-6245
ISBN:	18064314
Publisher:	Schattauer
Language:	English
Submitter:	Factscience Import
Date Deposited:	04 Oct 2013 14:54
Last Modified:	29 Mar 2023 23:32
Publisher DOI:	10.1160/TH07-07-0444
PubMed ID:	18064314
Web of Science ID:	000251687400009
URI:	https://boris.unibe.ch/id/eprint/22890 (FactScience: 37598)