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Bedside monitoring of anticoagulation in chronic haemodialysis patients treated with tinzaparin

Ruben Pauwels, Katrien Devreese (UGent) , Wim Van Biesen (UGent) , Sunny Eloot (UGent) , Griet Glorieux (UGent) , Raymond Vanholder (UGent) and Annemieke Dhondt (UGent)
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Abstract
Background. During haemodialysis, anticoagulants are required to prevent clotting in the extracorporeal circuit. Low-molecular weight heparins (LMWH) are frequently used because of the ease of a single injection at the start of dialysis. Disadvantages of LMWH include the lack of a reliable bedside assay for measuring their anticoagulant effect. Methods. We investigated a bedside test for LMWH activity. The relationship between anti-Xa (chromogenic assay) and Hemonox point-of-care assay was evaluated in 21 dialysis patients (12 men and 9 women) with a median age of 71 years, receiving tinzaparin at the start of a haemodiafiltration session. Results. At the start, before tinzaparin administration, median (interquartile ranges) of Hemonox values were 74 (67–82) s. Thirty minutes after tinzaparin administration, Hemonox values were increased to 496 (360–736) s, followed by a decrease to 149 (135–301) s after 120 min, 102 (97–144) s after 180 min and 92 (83–100) s after 240 min. Corresponding anti-Xa activities were 0 (0–0), 1.12 (0.9–1.29), 0.74 (0.57–0.96), 0.47 (0.31–0.7) and 0.31(0.16–0.49) IU/mL. Hemonox values showed an exponential relation to anti-Xa levels. Interchangeability of tests was shown by Bland–Altman plot. Conclusion. Point-of-care Hemonox test is a valuable bedside method for monitoring anti-Xa activity in dialysis patients anticoagulated with tinzaparin.
Keywords
tinzaparin, Hemonox, lowmolecular weight heparin, anti-Xa activity, haemodialysis, MOLECULAR-WEIGHT HEPARIN, ENOXAPARIN, POINT

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Chicago
Pauwels, Ruben, Katrien Devreese, Wim Van Biesen, Sunny Eloot, Griet Glorieux, Raymond Vanholder, and Annemieke Dhondt. 2014. “Bedside Monitoring of Anticoagulation in Chronic Haemodialysis Patients Treated with Tinzaparin.” Nephrology Dialysis Transplantation 29 (5): 1092–1096.
APA
Pauwels, Ruben, Devreese, K., Van Biesen, W., Eloot, S., Glorieux, G., Vanholder, R., & Dhondt, A. (2014). Bedside monitoring of anticoagulation in chronic haemodialysis patients treated with tinzaparin. NEPHROLOGY DIALYSIS TRANSPLANTATION, 29(5), 1092–1096.
Vancouver
1.
Pauwels R, Devreese K, Van Biesen W, Eloot S, Glorieux G, Vanholder R, et al. Bedside monitoring of anticoagulation in chronic haemodialysis patients treated with tinzaparin. NEPHROLOGY DIALYSIS TRANSPLANTATION. 2014;29(5):1092–6.
MLA
Pauwels, Ruben, Katrien Devreese, Wim Van Biesen, et al. “Bedside Monitoring of Anticoagulation in Chronic Haemodialysis Patients Treated with Tinzaparin.” NEPHROLOGY DIALYSIS TRANSPLANTATION 29.5 (2014): 1092–1096. Print.
@article{4301496,
  abstract     = {Background. During haemodialysis, anticoagulants are required to prevent clotting in the extracorporeal circuit. Low-molecular weight heparins (LMWH) are frequently used because of the ease of a single injection at the start of dialysis. Disadvantages of LMWH include the lack of a reliable bedside assay for measuring their anticoagulant effect.
Methods. We investigated a bedside test for LMWH activity. The relationship between anti-Xa (chromogenic assay) and Hemonox point-of-care assay was evaluated in 21 dialysis patients (12 men and 9 women) with a median age of 71 years, receiving tinzaparin at the start of a haemodiafiltration session.
Results. At the start, before tinzaparin administration, median (interquartile ranges) of Hemonox values were 74 (67--82) s. Thirty minutes after tinzaparin administration, Hemonox values were increased to 496 (360--736) s, followed by a decrease to 149 (135--301) s after 120 min, 102 (97--144) s after 180 min and 92 (83--100) s after 240 min. Corresponding anti-Xa activities were 0 (0--0), 1.12 (0.9--1.29), 0.74 (0.57--0.96), 0.47 (0.31--0.7) and 0.31(0.16--0.49) IU/mL. Hemonox values showed an exponential relation to anti-Xa levels. Interchangeability of tests was shown by Bland--Altman plot.
Conclusion. Point-of-care Hemonox test is a valuable bedside method for monitoring anti-Xa activity in dialysis patients anticoagulated with tinzaparin.},
  author       = {Pauwels, Ruben and Devreese, Katrien and Van Biesen, Wim and Eloot, Sunny and Glorieux, Griet and Vanholder, Raymond and Dhondt, Annemieke},
  issn         = {0931-0509},
  journal      = {NEPHROLOGY DIALYSIS TRANSPLANTATION},
  keyword      = {tinzaparin,Hemonox,lowmolecular weight heparin,anti-Xa activity,haemodialysis,MOLECULAR-WEIGHT HEPARIN,ENOXAPARIN,POINT},
  language     = {eng},
  number       = {5},
  pages        = {1092--1096},
  title        = {Bedside monitoring of anticoagulation in chronic haemodialysis patients treated with tinzaparin},
  url          = {http://dx.doi.org/10.1093/ndt/gft508},
  volume       = {29},
  year         = {2014},
}

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