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Objective and Design: Tinzaparin and dalteparin are low atomic weight heparins (LMWHs) with adapted pharmacokinetic and pharmacodynamic profiles that may advance to differences in ability and safety. In a long-term, multicentre, prospective, randomised balloon we compared the ability and assurance profiles of tinzaparin and dalteparin (starting doses were adapted to commensurable anti-IIa activity). The sample admeasurement was affected to appearance a about aberration of 50% in unsatisfactory dialyses with a ability of 80% (to prove superiority).Patients: 159 patients ability abiding alternate haemodialysis were included in the study.Main Outcome Measures: Ability was adjourned by scoring the dialyser (from 1 = good, bright dialyser to 4 = complete array of the dialyser acute a change of the extracorporeal circuit) and balloon catcher (from 1 = no clots to 4 = astringent clotting) afterwards anniversary dialysis. Levels of thrombin antithrombin complexes (TAT) were additionally determined. Assurance was adjourned by acquainted all accessory and above bleeding.Results: The beggarly anticoagulant dosage for tinzaparin during the aliment appearance was about 10% lower than that of dalteparin: 5024 ± 2321 (range 700-12000) anti-Xa IU and 5546 ± 2395 (1875-12913) anti-Xa IU, respectively. No aberration was begin amid treatments in array for either the dialyser or the balloon catcher (p = 0.59). TAT levels showed no aberration amid tinzaparin and dalteparin. The cardinal of accessory bleeds did not alter amid treatments: 1.5% (40/2629 dialyses) for tinzaparin and 1.4% (41/2863 dialyses) for dalteparin, and one above drain occurred in anniversary analysis arm.Conclusions: Dosage adding of tinzaparin and dalteparin according to anti-IIa action resulted in agnate ability and safety, although this was accomplished with a 10% lower dosage of tinzaparin abstinent in anti-Xa IU. Both LMWHs can be cautiously administered over a advanced dosage ambit in patients ability abiding alternate haemodialysis.

In abounding countries low atomic weight heparins (LMWHs) accept replaced unfractionated heparin for break including the prophylaxis and analysis of thrombosis.[1,2,3] LMWH affairs accept a lower beggarly atomic weight, added bioavailability and a best half-life than unfractionated heparin, and dose-independent clearance.[1,2,3,4] These backdrop accomplish LMWHs added anticipated anticoagulants than unfractionated heparin, which is advantageous during haemo-dialysis.

The capital advantage of LMWH over unfractionated heparin in haemodialysis is that one predialysis intravenous bolus bang is acceptable to accomplish the procedure.[4] For example, a audible bolus of 4250 IU of tinzaparin bargain dialyser array decidedly compared with unfractionated heparin during abiding haemodialysis (p < 0.01).[5] In this abstraction there was no aberration in bleeding time afterwards decannulation or in array in the venous chamber. Similarly, a dose-finding abstraction approved that a audible bolus dosage of dalteparin 70 IU/kg finer inhibited cogent agglomeration in the balloon allurement or dialyser during abiding haemodialysis.[6] Audible bolus doses of added LMWHs accept approved a abatement in array accumulation compared with a connected beverage of unfractionated heparin.[7]

Adapted actinic methods are acclimated to accomplish the LMWHs from awkward unfractionated heparin (for example, nitrous acerbic depolymerisation for dalteparin and heparinase assimilation for tinzaparin); the adapted anti-Xa: anti-IIa ratios aftereffect in adapted pharmacokinetic and biological properties[8,9] ( Table I ). It is accordingly accessible that the anatomy and pharmacokinetic profiles of the adapted LMWHs could aftereffect in adapted ability and assurance profiles. It is clinically important to recognise that anniversary LMWH is a audible ameliorative entity, and that extrapolation of backdrop from one LMWH to addition afterwards acceptable abstracts is unwise.

The practicalities of dosage acclimation of unfractionated heparin and LMWH back acclimated for anticoagulation during haemodialysis accept been investigated. Dosage of anniversary LMWH should be individualised, back a about-face from unfractionated heparin to LMWH, or dosage acclimation for patients already demography a LMWH, can aftereffect in an adapted agglomeration addiction with important analytic consequences.[13,14] In the tinzaparin abstraction cited earlier, the about-face arrangement of LMWH to unfractionated heparin activated decidedly with claret breeze amount and blazon of dialyser: the minimum all-important dosage of tinzaparin activated with body-weight, claret breeze amount and continuance of dialysis, and was afflicted by the accomplish of dialyser.[5]

It is accepted that tinzaparin has greater anti-IIa action than dalteparin, consistent in an anti-Xa: anti-IIa arrangement of 1.5-2.5 compared with 2-2.5 for dalteparin.[15] This could accept important implications for analytic practice, but to date few studies accept anon compared LMWHs. Dalteparin and tinzaparin are LMWHs that accept apart been apparent to be able anticoagulants during haemodialysis.[5,16,17,18,19,20] Back we conducted this abstraction dalteparin was the LMWH of best in haemodialysis, with a able-bodied accurate assurance and ability profile. We admired to analysis the almost new biologic tinzaparin adjoin this accustomed LMWH. In this long-term, prospective, randomised, multicentre, assessor-blinded analytic balloon we evaluated the complete and about ability and assurance of these two LMWHs afterwards administering to patients ability abiding alternate haemodialysis.

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