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Thromb Haemost 1988; 59(02): 240-247
DOI: 10.1055/s-0038-1642762
Original Articles
Schattauer GmbH Stuttgart

Low Molecular Weight Heparin in Haemodialysis for Chronic Renal Failure: Dose Finding Study of CY222

H Ireland
The Departments of Haematology and Medicine, Charing Cross and Westminister Hospital and Medical School, London, UK
,
D A Lane
The Departments of Haematology and Medicine, Charing Cross and Westminister Hospital and Medical School, London, UK
,
A Flynn
The Departments of Haematology and Medicine, Charing Cross and Westminister Hospital and Medical School, London, UK
,
A C Pegrum
The Departments of Haematology and Medicine, Charing Cross and Westminister Hospital and Medical School, London, UK
,
J R Curtis
The Departments of Haematology and Medicine, Charing Cross and Westminister Hospital and Medical School, London, UK
› Author Affiliations
Further Information

Publication History

Received 31 July 1987

Accepted after revision 03 December 1987

Publication Date:
21 May 2018 (online)

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Summary

A dose finding study of the very low molecular weight heparin CY222 (MW 2500) in patients (n = 8) with chronic renal failure undergoing dialysis has been carried out to (i) establish an effective dose and (ii) determine the relationship between ex vivo anti-factor Xa levels in plasma and the anticoagulant effect (in vivo suppression of FPA levels). Doses of CY222 were compared to a dose (5000 iu bolus + 1500 iu/hr) of unfractionated heparin (UFH) that has been shown to suppress FPA levels during prolonged (>5 hr) dialysis (Ireland et ah, J Lab Clin Med 103, 643, 1984). CY222 given iv in increasing doses produced a dose related increase in anti-factor Xa levels (measured as Institute Choay u/ml, with CY222 itself as standard) and suppression of FPA levels. When given in its highest dose, 20,000 Institute Choay u bolus + 1500 Institute Choay u/hr, there was little effect upon KCCT, FPA levels were statistically indistinguishable from those of the UFH regime (indicating comparable anticoagulant effect), but anti-factor Xa levels (expressed in Institute Choay u/ ml) were 2-3 times those of UFH (expressed in iu/ml). All samples were also assayed for anti-factor Xa level against the proposed low MW Heparin Standard. Plasma levels of CY222 were then found to be 2.78 times lower, so that the anti-factor Xa levels of CY222 required to produce comparable anticoagulant effect were then indistinguishable from those of UFH. Clinically, doses of CY222 exceeding 10,000 Institute Choay u bolus were effective, although increasing amounts of fibrin were visible in the drip chamber of the dialyser circuit with decreasing dose. These results indicate that CY222 is an effective anticoagulant for haemodialysis that can be monitored by its anti-factor Xa level in plasma (in conjunction with the appropriate standard). For prolonged dialysis a dose of 20,000 Institute Choay u bolus + 1500 Institute Choay u/hr is effective at suppressing fibrin formation, while the maintenance infusion may be unnecessary for short frequent dialyses.

Keywords

LMW heparin C - CY222 - Haemodialysis
 

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