Profile of low molecular weight tinzaparin sodium for anticoagulation during hemodialysis

Low-molecular-weight heparin (LMWH) has been suggested as providing safe, efficient, convenient, and possibly more cost-effective anticoagulation for hemodialysis (HD) than unfractionated heparin (UFH) with a single bolus dose at the start of hemodialysis effectively prevents clot formation in the dialyzer and bubble trap with fewer side-effects and possible benefits on uremic dyslipidemia. In this study, we compared the safety, clinical efficacy, and cost effectiveness of tinzaparin sodium (Innohep) with unfractionated heparin (UFH) in 23 chronic HD patients; their extracorporeal anticoagulant protocol consisted of UFH was switched to tinzaparin for a period of 6 months. Clinical clotting (grade 1-4) was evaluated by visual inspection after blood draining of the air trap every hour and the dialyzer after each session. Anticoagulation with tinzaparin sodium resulted in less frequent dialyzer and air-trap clotting compared to UFH (P= 001 and 0.04 respectively). Over 24 weeks, we observed no alteration in the serum lipid profile of the patients. There was a statistically significant improvement in the dialysis single pool Kt/V after 6 months of tinzaparin use (1.40 + or - 0.28 for tinzaparin versus 1.23 + or - 0.28 for heparin) without any modification in the hemodialysis prescription. The total cost for 24 weeks use of tinzaparin sodium was 23% more expensive compared to that for UFH. We conclude that a single bolus of Tinzaparin sodium injection at the start of the dialysis session was more effective and convenient in our patients than UFH, but at a higher total cost. Furthermore, at least on the short term, there was no observed benefit on the lipid profile.