Low-molecular-weight heparin for routine hemodialysis

Unfractionated heparin (UFH) is a series of molecules, and as such has variable pharmacodynamics. Low-molecular-weight heparins were developed to improve both drug pharmacokinetics and dynamics, so as to provide a reliable clinical effect. These are potent agents, but have an increased half-life compared with UFH in dialysis patients, and also require special laboratory monitoring. We switched our chronic hemodialysis patients from unfractionated to low-molecular-weight heparins. Low-molecular-weight heparins proved to be effective in preventing extracorporeal circuit clotting, and safe with fewer bleeding episodes and heparin-induced thrombocytopenia than standard UFH. Indeed, we stopped routine laboratory monitoring because of the lack of side effects, and simply dosed by clinical inspection of the extracorporeal circuit for thrombus, and the time for fistula needle sites to stop bleeding. These agents have become the anticoagulants of choice in Europe for routine outpatient hemodialysis sessions, not only due to reduced drug costs but also due to the reliability of their clinical effect and ease of administration.