Effects of different doses of low molecular weight heparin on the patency rate of cuffed central venous catheter of hemodialysis_West China Medical Journal

Authors：

 LI Xinyi ¹ , WANG Xiaojing ² , CHEN Wei ¹ , HUANG Nan ¹

1. Department of Physical Examination, 363 Hospital, Chengdu, Sichuan 610041, P. R. China;
2. Department of Internal Medicine, Wangjiang Hospital of Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LI Xinyi, Email: lisali591@hotmail.com

Keywords：

Low molecular weight heparin; Hemodialysis; Patency rate of catheter

DOI：

10.7507/1002-0179.201912017

Video：

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Objective To explore the effect of different doses of low molecular weight heparin (LMWH) on the patency rate of cuffed central venous catheter used by patients for hemodialysis therapy.Methods From June 2012 to January 2018, patients who received long-term hemodialysis in 363 Hospital with cuffed central venous catheter were enrolled in this retrospective study. According to the dose of LMWH used in hemodialysis, they were divided into below 60 U/kg group and greater than or equal to 60 U/kg group. The general parameters, frequency of urokinase use, bleeding events, severe coagulation in dialysis line and occurrence of catheter dysfunction were collected and compared between two groups.Results A total of 48 cases were enrolled. Of these, the doses of LMWH of 31 cases were below 60 U/kg and 17 cases were greater than or equal to 60 U/kg. There was no significant difference between the two groups in terms of age, sex, diabetes, hemoglobin, platelets, albumin, low-density lipoprotein cholesterol, or hypersensitive C-reactive protein parameters (P>0.05). Between the below 60 U/kg group and the greater than or equal to 60 U/kg group, there was no statistically significant difference in the incidence of catheter dysfunction (16.1% vs. 29.4%; χ²=0.507, P=0.476) or the incidence of bleeding events (1.77 vs. 2.81 times per 1 000 catheter-days; χ²=1.500, P=0.221). The frequency of urokinase used in the two group were 27.89 and 36.18 times per 1 000 catheter-days, respectively (χ²=5.927, P=0.015) and the frequency of severe coagulation were 6.88 and 2.30 times per 1 000 catheter-days, respectively (χ²=5.140, P=0.023). The differences were statistically significant.Conclusion The lower dose of LMWH used in hemodialysis for preventing extra-corporeal circuit thrombosis does not result in the decrease of the patency rate of cuffed central venous catheter.

Citation： LI Xinyi, WANG Xiaojing, CHEN Wei, HUANG Nan. Effects of different doses of low molecular weight heparin on the patency rate of cuffed central venous catheter of hemodialysis. West China Medical Journal, 2020, 35(7): 809-812. doi: 10.7507/1002-0179.201912017 Copy

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12.	Stefoni S, Cianciolo G, Donati G, et al. Standard heparin versus low-molecular-weight heparin. A medium-term comparison in hemodialysis. Nephron, 2002, 92(3): 589-600.
13.	中国医院协会血液净化中心管理分会血液净化通路学组. 中国血液透析用血管通路专家共识(第1版). 中国血液净化, 2014, 13(8): 549-558.
14.	Allon M, Brouwer-Maier DJ, Abreo K, et al. Recommended clinical trial end points for dialysis catheters. Clin J Am Soc Nephrol, 2018, 13(3): 495-500.
15.	中华医学会外科学分会血管外科学组. 深静脉血栓形成的诊断和治疗指南(第三版). 中国血管外科杂志(电子版), 2017, 9(4): 250-257.
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19.	孙雪峰. 血液透析中合理应用低分子肝素. 中国实用内科杂志, 2008, 28(4): 319-320.

1. Pantelias K. Vascular access today. World J Nephrol, 2012, 1(3): 69-78.
2. Donati G, Colì L, Cianciolo G, et al. Thrombosis of tunneled-cuffed hemodialysis catheters: treatment with high-dose urokinase lock therapy. Artif Organs, 2012, 36(1): 21-28.
3. Bonkain F, Van Hulle F, Janssens P, et al. Urokinase-containing locking solution in the prevention of dialysis catheter dysfunction: a double blind randomized controlled trial. J Vasc Access, 2017, 18(5): 436-442.
4. MacRae JM, Ahmed A, Johnson N, et al. Central vein stenosis:a common problem in patients on hemodialysis. ASAIO J, 2005, 51(1): 77-81.
5. Gunawansa N, Sudusinghe DH, Wijayaratne DR. Hemodialysis catheter-related central venous thrombosis: clinical approach to evaluation and management. Ann Vasc Surg, 2018, 51: 298-305.
6. Leblanc M, Bosc JY, Paganini EP, et al. Central venous dialysis catheter dysfunction. Adv Ren Replace Ther, 1997, 4(4): 377-389.
7. 黄琪, 孙雪峰, 林洪丽, 等. 维持性血液透析血管通路抗凝治疗多中心流行病学研究. 中国实用内科杂志, 2014, 34(6): 579-583.
8. Han X, Yang X, Huang B, et al. Low-dose versus high-dose heparin locks for hemodialysis catheters: a systematic review and meta-analysis. Clin Nephrol, 2016, 86(7): 1-8.
9. Davenport A. The rationale for the use of low molecular weight heparin for hemodialysis treatments. Hemodial Int, 2013, 17(Suppl 1): S28-S32.
10. Lim W, Cook DJ, Crowther MA. Safety and efficacy of low molecular weight heparins for hemodialysis in patients with end-stage renal failure: a meta-analysis of randomized trials. J Am Soc Nephrol, 2004, 15(12): 3192-3206.
11. 陈香美. 血液净化标准操作规程. 北京: 人民军医出版社, 2011: 46.
12. Stefoni S, Cianciolo G, Donati G, et al. Standard heparin versus low-molecular-weight heparin. A medium-term comparison in hemodialysis. Nephron, 2002, 92(3): 589-600.
13. 中国医院协会血液净化中心管理分会血液净化通路学组. 中国血液透析用血管通路专家共识(第1版). 中国血液净化, 2014, 13(8): 549-558.
14. Allon M, Brouwer-Maier DJ, Abreo K, et al. Recommended clinical trial end points for dialysis catheters. Clin J Am Soc Nephrol, 2018, 13(3): 495-500.
15. 中华医学会外科学分会血管外科学组. 深静脉血栓形成的诊断和治疗指南(第三版). 中国血管外科杂志(电子版), 2017, 9(4): 250-257.
16. Green MS, Tellor KB, Buckallew AR. Safety and efficacy of enoxaparin compared with unfractionated heparin for venous thromboembolism prophylaxis in hemodialysis patients. Hosp Pharm, 2017, 52(9): 623-627.
17. Hollenbeck M, Niehuus A, Wozniak G, et al. Central venous catheters as access for acute and long-term dialysis. Chirurg, 2012, 83(9): 801-808.
18. 李京, 戴晓霞, 张宜默, 等. 血液透析长期中心静脉留置导管功能不良发生率及影响因素分析. 中国血液净化, 2010, 9(4): 178-181.
19. 孙雪峰. 血液透析中合理应用低分子肝素. 中国实用内科杂志, 2008, 28(4): 319-320.

West China Medical Journal

Effects of different doses of low molecular weight heparin on the patency rate of cuffed central venous catheter of hemodialysis

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