LONG-TERM USE OF THE LOW-MOLECULAR-WEIGHT HEPARIN TINZAPARIN IN HEMODIALYSIS

Fifty-two patients with chronic renal failure undergoing hospital haem odialysis were given a single bolus dose of tinzaparin (Innohep, Leo L aboratories, UK) into the arterial side of the dialyser, for up to 43 consecutive dialyses. The mean tinzaparin dose at the beginning was 2, 139 IU anti-Xa and at the end 2,186 IU anti-Xa. Overall, tinzaparin pr oved a satisfactory anticoagulant for 1,370 (96.0%) out of 1,427 dialy ses. Significant clot formation was prevented in 1,326 (92.8%) out of 1,429 dialyses. The clinically effective dose was associated with a me an plasma anti-Xa activity 1 h after dosing of 0.4 IU/ml and suppresse d fibrinopeptide A formation for up to 4 h. Bleeding, from the skin or mucous membranes, was recorded at 27 (1.9%) of 1,408 dialyses. Prolon ged fistula bleeding on completion of dialysis was recorded on only 20 occasions. Other haemorrhagic events included haematemesis, bruising and subconjunctival haemorrhage (each in 1 patient) and epistaxis (2 p atients). Three patients died during the study of causes considered un related to tinzaparin therapy, myocardial infarction (2 patients) and multiple myeloma. Other adverse events reported included vomiting (3 p atients) and hypotension (3 patients). Three patients ceased treatment due to haematemesis, prolonged bleeding from fistula puncture and thr ombosis of the arteriovenous access, respectively. A small, but statis tically significant, increase within the normal reference range was re corded in the mean values for aspartate aminotransferase and alanine a minotransferase.