Effect of vitamin E coated dialyzers on anticoagulation requirement in hemodialyzed children

Abstract

As hemodialysis (HD) requires extracorporal blood flow and the need for anticoagulation, we evaluated the effect of vitamin E coated membranes (VIE) on the requirement of low molecular weight heparin (LMWH) in pediatric HD patients.

Patients and methods: seven children and adolescents on regular hemodialysis were started on VIE and their LMWH dose was decreased every week. In order to monitor the requirement of LMWH we used a coagulation score to evaluate coagulation in the dialyzer, air trap and blood line. Other classical parameters (hemoglobin, erythropoietin dose, inflammatory markers) were monitored weekly while the patients were on VIE dialyzers. LMWH dose during the 1st week was 110 IU/kg +/- 18 (defined as 100%), in the 2nd week the dose was 77 IU/kg +/- 12 (70%), in the 3rd week the dose was 33 IU/kg +/- 5 (30%), and in the 4th week anticoagulation could be stopped in one patient, in the other six patients further decrease was impossible given the increase of the clotting score. There was no increase in clotting score during week one and two. During week three (while on 30% of the initial LMWH dose) six patients showed mild to moderate clotting phenomena: mild coagulation phenomena in three patients and moderate clotting phenomena in three others. One patient did not show any clotting phenomena in week three and LMWH was totally stopped. In conclusion, use of VIE dialyzers may help to reduce the requirement of anticoagulation in pediatric HD patients reducing bleeding problems and simplify hemostasis after HD sessions.