PREVENTION OF COAGULATION IN THE EXTRACOR POREAL CIRCUIT DURING HEMODIALYSIS WITH ENOXAPARINE - OPTIMIZATION OF THE DOSAGE THROUGH A MULTICENTER STUDY

In order to define the optimal dosage of a low molecular weight enoxap arine (Lovenox(R)) in the prevention of clotting in extracorporeal cir culation during hemodialysis, a multicentre trial was conducted in 72 patients dialysed in seven hemodialysis units. During three weeks, the se patients received as antithrombic treatment a single injection of e noxaparine at the beginning of the session. The initial dose fixed by previous data concerning dialysis with high hemorrhagic risks patients was 0,5 mg/kg (50 Ul Anti-Xa/kg). According to the evaluation of thro mbotic manifestations during a 4 hour dialysis, the dosage was progres sively increased if necessary for each patient. For 41% patients, the initial dose of 0,5 mg/kg was maintained along the whole study; 59% pa tients needed higher dose, between 0,6 and 0,9 mg/kg. The mean dose fo r the whole patient population at the end of the study was 0,62 +/- 0, 16 mg/kg. No complication nor side effect was noted. The influence of blood flow, nature of dialysis membrane, level of hematocrit was studi ed. In conclusion, 0,5 mg/kg of enoxaparine can prevent thrombotic man ifestations in almost half of chronic hemodialysed patients with good results. Further studies could precise the place of personal or techni cal parameters in the choice of the optimal dose for each patient.