Effects of Changing Anticoagulation with Unfractionated Heparin into Enoxaparin in Hemodialysis Patients:Prospective Non Randomized Unicentre Study

Background: Maintaining the patency of the extracorporeal circuit (ECC) is required. The cost and long-term effect of anticoagulants on hemodialysis (HD) patients' parameters are still matters of concern. We aimed to study the effect of shifting to enoxaparin instead of unfractionated heparin (UFH) during HD and evaluate its efficacy, safety, and benefits.

Design and methodology: This study was conducted at Arar hospital, Kingdom of Saudi Arabia (KSA), and included 86 end-stage renal disease (ESRD) patients on HD for six months starting from October 2017. All patients had been on UFH as an anticoagulant during hemodialysis sessions before they were shifted to equivalent doses of enoxaparin sodium (Clexan®) as a therapeutic upgrade to start with. The patients’ files were examined retrospectively for the period of UFH therapy and then all patients were observed prospectively for at least 6 months while on Clexane. The occurrence of clotting in the dialysis sets were recorded and the need for urgent HD for each patient and the reasons.

Results: There was a reduction of filter clots even with the reduction of enoxaparin dose. There was a significant reduction of mean cholesterol, calcium, phosphorus, sodium, chloride, and serum osmolality. We found a significant reduction of pre-dialysis potassium among those who presented with a pre-dialysis potassium of higher than 5.5 mg/dl during the enoxaparin phase. Patients, who had thrombocytopenia while on UFH; showed improvement in platelet count after the shift to enoxaparin. However, patients who had platelet count lowered than 150000/mm3 6 months after having been shifted to enoxaparin; many of them received HD through a permanent catheter. No patients had a three-fold increase of normal values (3ULN) of liver function tests whether being on heparin or enoxaparin.

Conclusion: Low molecular weight heparin (LMWH) could be more efficacious and safe than UFH with the improvement of some variables in HD patients.