Question

Is Innohep (low molecular weight heparin) or heparin better for haemodialysis patients and why?

Most patients in our unit are on heparin which causes thrombocytopenia to some patients.
May 15, 2012

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  • Karen Huang · Afilliated hospital of Pharmacy
    We found heparin is better for haemodialysis patients .
    May 16, 2012
  • Joachim Beige · Klinikum St. Georg Leipzig
    3 years ago, we switched from heparin to Enoxaparin (Clexane), another LMW in our 160pts dialysis unit. Overall, there were no problems with clotting and a goof anticoagulation control adapted by a-Xa levels. However, sometime a second bolus is needed in long sessions and LMW are in general more expensive than heparin. The advantage is to skip the syringe an tubing for heparin. HIT 2 does not seem a problem in HD with any of the substances.
    May 16, 2012
  • Liqingchu Liqingchu · Guilin Medical University
    Our unit usually use heparin ,LMW are in general more expensive than heparin.few use LMW.
    May 16, 2012
  • Joachim Beige · Klinikum St. Georg Leipzig
    yes, but the dosage (and costs) can be kept usually 50% below recommendations. Given this and skipping syringe, tubing and efforts, there is not much difference to heparin. JB
    May 16, 2012
  • Vladimir Ryasnyanskiy
    Half-life of LMW heparin in dialysis patients is twice longer than in pts without renal problem. Bleeding risk can be greater. Practically we have not such problem (unit for 100 pts, 50% on LMWH). It"s a good practice to control a-Xa levels, but for us is too expensive.
    May 16, 2012
  • Giorgio Triolo · Centro Traumatologico Ortopedico, Maria Adelaide
    We always utilize sodic heparin mainly for economic reasons
    May 16, 2012
  • Xin Wu · Fresenius Medical Care
    In our unit, we have been using LMW clexane injecting to the arterial line at the beginning of hemodialysis. The varied dose is usually based on the weights of patients. As for patients with oncoming invasive operation, they would put on heparin syringe. I observed LMW clexane is convenient to use and less complications involved.
    May 17, 2012
  • Roop Kishen · The University of Manchester
    Low molecular weight (LMW) heparins like innohep can be used in haemodialysis or continuous forms of renal replacemnet therapy . However, there is the question of cost (LMW heparins are costlier) as well as prolonged pharmacological effect in patients with renal failure. Also, if the patient needs to go to operating theatre for emergency surgery, reversing the effect of LMW is not easy. These points have to be kept in mind.
    May 18, 2012
  • Sameer Alarrayed · Arabian Gulf University
    Use of low molecular weight heparin for hemodialysis: a short-term study.

    Sameer Al-Arrayed, Rajagopalan Seshadri

    Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia. 13(2):146-50.
    May 20, 2012
  • Swapnil Hiremath · Ottawa Hospital Research Institute
    There was a debate at the Canadian Society of Nephrology annual meeting in May this year - which is actually available online here: http://vimeo.com/42178151. From my recollection of that debate, the evidence for LMWH being as safe and as effective as unfractionated heparin (safety and efficacy being two different points) is weak, mainly from a lack of large trials. This point is also made in an older systematic review: http://jasn.asnjournals.org/content/15/12/3192.abstract .
    As far as cost is concerned - obviously with the caveat that cost is different in different countries- the cost of unfractionated heparin in Canada and the US has increased, especially after the scandal with contaminants found in Baxter's suppliers from China (http://www.nytimes.com/2008/03/30/weekinreview/30bogdanich.html?_r=1&ref=heparindrug) bringing LMWH within reach as far as cost is concerned. The cons of UFH also include unpredictable dose-response effect compared to LMWH and also better side effect profile. The cons of LMWH, apart from cost, include a longer effect even after a single dose with a higher potential bleeding risk.
    Remember though that all LMWH are not the same - Tinzaparin (Innohep - Leo Pharma) seems to have a shorter half life than Dalteparin (Fragmin - Pfizer) which may have a shorter half life than enoxaprin (Lovenox - Sanofi).
    Swapnil
    Sep 4, 2012
  • Sergiu Dumitrache · C Davila Teaching hospital of Nephrology
    in my experience, they are effectively equal. We are using now innohep beeing cheaper than heparin
    Sep 25, 2012
  • Abdul Karim Sheiban · Sana'a University
    We still using Heparin, in some cases with thrombocytopenia ,pts were shiftted to clexane.
    Sep 25, 2012
  • Elpida Antoniadou · Hippokration General Hospital, Thessaloniki
    I agree with Mr.Vaina
    Oct 4, 2012
  • Andreas Vainas ·
    LMWH (Innohep, Ivor) when prescribed at the adequate dose in dialysis patients are superior to the UFH with similar bleeding side effects. Besides UFH is implicated in bone disease and hyperlipidemia. Unfortunately cost does matter with UFH being cost effective, at least in Greece.
    Nov 8, 2012
  • Mohamed Lisri · Centre Hospitalier Universitaire Mohammed VI
    since two to three years we used LMW heparin in our dialysis patients without no more bleeding complications. we set doses only on clincal evaluation. the lonly inconvinient is cost
    heparin is so difficult to obtaine heparin in our contry
    Dec 31, 2012

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