The adequacy of fragmin as a single bolus dose with reused dialyzers

Thirty-four hemodialysis patients were studied in a crossover fashion to compare the effectiveness of bolus-dose Fragmin (a low molecular weight heparin) with regular heparin usage in hemodialysis. For each anticoagulant, 3 dialyzes were studied for each patient; the first sessions involved a new dialyzer, and the subsequent sessions involved dialyzers reprocessed with peracetic acid. To assess the effectiveness of the anticoagulation regimens, the following were measured: the dialyzer fiber bundle volume and the instantaneous dialyzer clearances for urea (1 h into the second session). In addition, factor Xa levels were measured in 5 patients during the first and second sessions at 0 min, 30 min, and 4 h. Fiber bundle volumes were (in ml) 75.4 +/- 8.8, 73.0 +/- 8.9, and 73.5 +/- 7.6 on first, second, and third uses with Fragmin (p = ns); and 77.8 +/- 9.0, 73.4 +/- 8.1, and 73.8 +/- 8.1 with heparin (p < 0.001 second and third vs. first). Thus, there were no significant differences between Fragmin and heparin. Instantaneous dialyzer clearances were 165.8 +/- 12.6 ml/min with Fragmin and 163.8 +/- 9.8 with heparin (p = ns). Factor Xa levels were 0 predialysis, 0.81 +/- 0.17 U/ml at 30 min on first use, and 0.92 +/- 0.09 U/ml on second use (p = ns); they were 0.51 +/- 0.21 U/ml at 4 h on first use and 0.61 +/- 0.16 U/ml on second use (p = ns). Thus, bolus-dose Fragmin provided similar results to constant infusion heparin and is not deleteriously influenced by reprocessing dialyzers with peracetic acid.