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Randomized Controlled Trial
. 2010 Dec 6:11:33.
doi: 10.1186/1471-2369-11-33.

Lipoprotein lipase responds similarly to tinzaparin as to conventional heparin during hemodialysis

Dana Mahmood  1 , Maria Grubbström, Lennart D I Lundberg, Gunilla Olivecrona, Thomas Olivecrona, Bernd G Stegmayr
Affiliations
Randomized Controlled Trial

Lipoprotein lipase responds similarly to tinzaparin as to conventional heparin during hemodialysis

Dana Mahmood et al. BMC Nephrol. .

Abstract

Background: Low molecular weight (LMW) heparins are used for anticoagulation during hemodialysis (HD). Studies in animals have shown that LMW-heparins release lipoprotein lipase (LPL) as efficiently as unfractionated (UF) heparin, but are less able to retard hepatic uptake of the lipase. This raises a concern that the LPL system may become exhausted by LMW-heparin in patients on HD. We have explored this in the setting of clinical HD.

Methods: Twenty patients on chronic hemodialysis were switched from a primed infusion of UF-heparin to a single bolus of tinzaparin. There were long term follow up of variables for the estimation of dialysis efficacy as well as of the LPL release during dialysis and the subsequent impact on the triglycerides.

Results: The LPL activity in blood was higher on tinzaparin at 40 but lower at 180 minutes during HD. These values did not change during the 6 month study period. There were significant correlations between the LPL activities in individual patients at the beginning and end of the 6 month study period and between the activities on UF-heparin and on tinzaparin, indicating that tissue LPL was not being exhausted. Triglycerides were higher during the HD-session with tinzaparin than UF-heparin. The plasma lipid/lipoprotein levels did not change during the 6 month study period, nor during a 2-year follow up after the switch from UF-heparin to tinzaparin. Urea reduction rate and Kt/V were reduced by 4 and 7% after 6 months with tinzaparin.

Conclusion: Our data demonstrate that repeated HD with UF-heparin or tinzaparin does not exhaust the LPL-system.

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Figures

Figure 1
Figure 1
Flow chart of the study.
Figure 2
Figure 2
Median LPL activities in plasma during dialysis with UF-heparin or tinzaparin. UF-heparin - open circles and filled lines (at the points in time denoted "End heparin" in Figure 1); tinzaparin at start (i.e. after the run-in period) - open squares and hatched lines; tinzaparin 3 months - grey squares and hatched lines; tinzaparin 6 months - filled squares, dotted lines.
Figure 3
Figure 3
Correlation of LPL- activity in plasma 40 minutes after injection of tinzaparin at the points in time designated in figure 1 as Start tinzaparin and 6 months tinzaparin, respectively.
Figure 4
Figure 4
Correlation of LPL- activity in plasma 40 minutes after injection of a bolus of tinzaparin or after start of a primed infusion of UF-heparin. The values are from the points in time designated in figure 1 as Start heparin and Start tinzaparin, respectively
Figure 5
Figure 5
Test of the amount of LPL available in the system at 40 minutes and during the end of a HD with tinzaparin. A bolus of UF-heparin (50 units/kg body weight, intravenously) was given after 180 min of HD with tinzaparin to evaluate the extent of residual LPL on the endothelial sites. Eleven of the patients accepted to participate in this second step of investigation. Blood samples were taken at 180, 210 and 240 min (i.e. 0, 30 and 60 min after the bolus of UF-heparin).
Figure 6
Figure 6
Plasma triglyceride concentration during HD with UF-heparin (open circles and filled line) or tinzaparin (filled square and dotted line).
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References

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