BACKGROUND: The European Best Practice Guidelines on anticoagulation in chronic haemodialysis recommend the use of low-molecular-weight heparins (LMWH) over unfractionated heparin (UFH), based on previous small-scale studies and a meta-analysis which demonstrated equal efficacy of anticoagulation without an increase in hemorrhagic events. METHOD: We performed a prospective single-centre study where all stable patients on chronic in-hospital haemodialysis were converted from UFH to Tinzaparin. Patients were monitored for 2 months before and 2 months after the switch. Access failures due to thrombosis, clotted circuits and hemorrhagic events were recorded. RESULTS: 1,489 and 1,823 dialysis sessions took place on UFH and LMWH, respectively, in 108 patients (65 male). The total number of clotted circuits tended to decrease after the switch to LMWH (34 vs. 13) but was not statistically significant. There were four minor non-access-related episodes of haemorrhage while on treatment with UFH and none with Tinzaparin, and the length of bleeding time post needle removal was shorter with Tinzaparin than UFH. The cost-analysis demonstrated parity of Tinzaparin with UFH; using a median of 10,000 U of UFH versus 2,500 U of LMWH, each therapy cost GBP 10,783 (EUR 15,942; USD 20,446) per annum. CONCLUSION: Our findings suggest comparable safety and efficacy of Tinzaparin, parity of cost in comparison with UFH. Copyright 2008 S. Karger AG, Basel.
BACKGROUND: The European Best Practice Guidelines on anticoagulation in chronic haemodialysis recommend the use of low-molecular-weight heparins (LMWH) over unfractionated heparin (UFH), based on previous small-scale studies and a meta-analysis which demonstrated equal efficacy of anticoagulation without an increase in hemorrhagic events. METHOD: We performed a prospective single-centre study where all stable patients on chronic in-hospital haemodialysis were converted from UFH to Tinzaparin. Patients were monitored for 2 months before and 2 months after the switch. Access failures due to thrombosis, clotted circuits and hemorrhagic events were recorded. RESULTS: 1,489 and 1,823 dialysis sessions took place on UFH and LMWH, respectively, in 108 patients (65 male). The total number of clotted circuits tended to decrease after the switch to LMWH (34 vs. 13) but was not statistically significant. There were four minor non-access-related episodes of haemorrhage while on treatment with UFH and none with Tinzaparin, and the length of bleeding time post needle removal was shorter with Tinzaparin than UFH. The cost-analysis demonstrated parity of Tinzaparin with UFH; using a median of 10,000 U of UFH versus 2,500 U of LMWH, each therapy cost GBP 10,783 (EUR 15,942; USD 20,446) per annum. CONCLUSION: Our findings suggest comparable safety and efficacy of Tinzaparin, parity of cost in comparison with UFH. Copyright 2008 S. Karger AG, Basel.