FAN S1, SIMMONDS R1, MUNZEL R1, SOMERVILLE C1
1Department of Renal Medicine, Barwon Health, Geelong, Australia
Aim: To evaluate the safety and efficacy of enoxaparin use in the extended hour nocturnal home haemodialysis (NHHD) population, and to compare this to patients using unfractionated heparin (UFH).
Background: Anticoagulation is required for almost all patients receiving haemodialysis. The Barwon Health Home Haemodialysis Unit has been using enoxaparin administered by bolus followed by infusion in our NHHD population for nine years. Prior to 2011, UFH was used. These patients dialyse for 6-8 hours per night, 4-6 times per week. There is limited data to direct enoxaparin dosing in this cohort, and whether enoxaparin is safe and effective when compared with traditionally used UFH.
Methods: Single-centre retrospective analysis of all patients on NHHD using enoxaparin for dialysis from 2011 to 2020, and patients using UFH from 2001 to 2020. Demographics, type of anticoagulant, dose of enoxaparin were recorded. Occurrence of major bleeding events, thrombosis events, hospitalisations, interrupted dialysis, and surgical or endovascular interventions were recorded.
Results: 120 patients were included, with 67 patients (56%) in the enoxaparin group and 53 patients (44%) in the UFH group. The median total mg/kg dose of enoxaparin used per dialysis session was 0.81mg/kg. Between the enoxaparin and UFH groups, there were no statistically significant differences in the incidence of major bleeding (14.9% versus 15.1%, p=0.98), thrombosis (10.4% versus 20.8%, p=0.12), or hospitalisations (16.4% versus 28.3%, p=0.12). Patients on UFH did have a greater incidence of interrupted dialysis sessions (4.5% versus 22.6%, p=0.003) and requirement for surgical or endovascular interventions (9% versus 22.6%, p=0.037).
Conclusions: Enoxaparin at this dose is a safe and efficacious alternative to UFH, and may be associated with fewer complications.
Dr Sophy Fan is a second year Nephrology Advanced Trainee currently working at Austin Hospital.