LOW-MOLECULAR-WEIGHT HEPARIN REDUCES TRIGLYCERIDE, VLDL AND CHOLESTEROL HDL LEVELS IN HYPERLIPIDEMIC DIABETIC-PATIENTS ON HEMODIALYSIS/

Background: Low molecular weight heparin (LMWH) provides a safe and ef fective alternative for hemodialysis anticoagulation. While unfraction ated (UF) heparin has been implicated in hyperlipidemia, the effect of LMWH on the lipid profile in nondiabetic patients is controversial in chronic hemodialysis, The effect of LMWH in diabetic patients, a high risk group of hyperlipidemia, has not been studied. Method: LMWH was tested for its safety and efficacy in 10 nondiabetic Taiwanese patient s, To evaluate influence of lipid profile, a crossover study was carri ed out in 10 type II diabetic patients with poor blood sugar control a ssociated with high triglyceride (430.4 +/- 101.1 mg/dl) and total cho lesterol levels (219.2 +/- 12.7 mg/dl) using UF heparin for more than 1 year, These patients were subjected to Fraxiparine, an LMWH, for 6 m onths and then switched back to UF heparin for another 6 months. Lipid profiles were measured every 2 months without prescribing lipid-lower ing agents and the blood sugar was maintained at stationary levels, Re sults: LMWH is safe and effective in Taiwanese patients as a single bo lus injection and maintains a 9.4% higher platelet count immediate pos tdialysis compared to UF heparin, With high HbA1c levels (9.6 +/- 0.6% ), mean triglyceride and VLDL levels started to decrease at the 4th mo nth after LMWH treatment and reached a 34% reduction in triglyceride, a 26.2% reduction in VLDL, and a 19% reduction of total cholesterol/HD L ratio at the 6th month, Increments of triglyceride levels were found at the 6th month after a switch back to UF heparin. The levels of tot al cholesterol, LDL-cholesterol, HDL-cholesterol, apolipoprotein A-1 a nd B remained unchanged. Conclusion: LMWH may be beneficial to lipid c ontrol in hyperlipidemic diabetic patients on hemodialysis.