A review of 122 published outcomes of danaparoid anticoagulation for intermittent haemodialysis

Thrombosis Research
Harry N Magnani

Abstract

One hundred and twenty-two case reports of treatment outcomes of danaparoid use for intermittent haemodialysis (HD) in severely ill patients with heparin intolerance (including 97 HIT patients) have been analysed. HD sessions of 4 - 6 hours were successfully conducted daily to 3 times/week for periods of up to 4 years (median 7 sessions/patient (range 1 - >650). In these patients danaparoid use was relatively safe (4 unprovoked non-fatal major bleeds) and efficacious in protecting the circuit (95% no clotting problem) or patient (6 thromboses: 4 fatal or leading to danaparoid discontinuation). HIT diagnosis was improved if recurrent platelet count reduction with each HD and circuit/AV graft clotting were included. Alternative reasons for and very low nadirs of the platelet count undermined the usefulness of the 4 T pre-test HIT predictability scores, but a positive functional serological test confirmed HIT in most patients. Deaths (15.6%) and thrombosis only occurred in HIT cases. Possible reasons are discussed. Replacing the standard intermittent pre-HD dose regimen with the therapeutic infusion regimen to provide continuous daily systemic antithrombotic protection, should further improve efficacy. Danaparoid appears to be a u...Continue Reading

References

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Citations

May 9, 2012·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Jenny I Shen, Wolfgang C Winkelmayer
Aug 1, 2012·Orvosi hetilap·Klára Gadó, Gyula Domján
Feb 24, 2015·Journal of Vascular Nursing : Official Publication of the Society for Peripheral Vascular Nursing·Fahad A S Al-Eidan
Apr 27, 2016·Blood·Theodore E Warkentin, Julia A M Anderson
Oct 19, 2019·BMC Nephrology·Damien AshbyMartin Wilkie
Oct 24, 2020·Blood Advances·Rebecca L MorganNancy Santesso
Feb 5, 2021·Clinical and Applied Thrombosis/hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis·Harry N Magnani
Nov 3, 2020·Seminars in Dialysis·Sophie E ClaudelMariana Murea

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