A LWMH–Tinzaparin an Efficient and Safe Product for Anticoagulation in CRRT

One of the most drawbacks of CRRT is anticoagulation. Excessive anticoagulation determines bleeding complications; whole circuit clotting decreases dialysis effectiveness, increases blood loss and necessitates transfusions. The aim of the study was to evaluate efficacy and safety of Tinzaparin as anticoagulation for extracorporeal circuit in CRRT. The optimal necessary dose of tinzaparin was examined in 12 CRRT sessions, 7 CVVHDF (Qb =  134 ± 15.7 ml/min, Qd = 35 ± 7 ml/min, minimal UF =  500 ml/h, total time = 120.5 h) and 5 CVVH (Qb = 150 ± 13 ml/min, minimal UF = 500 ml/h, total time = 72.5 h) in 9 pts (M = 5, F = 4, mean age =  51.78 ± 8.9 y, BW = 60 ± 15.3 Kg) with acute renal failure and associated comorbidities. The initial dose of tinzaparin was 5 IU a Xa/Kgc in 2 pts with thrombocitopenia < 100.000/mm3 and 10 IU a Xa/Kgc in 5 pts without bleeding disorders, given as bolus in the arterial line at the start of CRRT, followed by an infusion of 10 IU aXa/kgc/h. Dose adjustments was made by increasing or decreasing dose with 2.5 IU a Xa/kgc/h. Anticoagulant efficiency was measure by absence or presence of clinical and pressure signs of clotting in dialyser or extracorporeal circuit. Mean dose of Tinzaparin was 540.3 ± 114.2 IU a Xa/h (range 400–800). Overall, Tinzaparin proved a satisfactory anticoagulation regime for all patients. In all pts clinical signs of clotting in dialyzer or lines during the CRRT sessions were absent. In 3 pts (66.6%) the dose of Tinzaparin was changed in the first five hours of CRRT sessions to prevent clotting, using pressure values. The tolerance of Tinzaparin was excellent for all dose levels used. In 1 pt (11.1%) minor hemorrhages (hemoptisis) appeard during CRRT session. No major hemorrhages appeared. Other adverse events due to Tinzaparin (thrombocitopenia) do not occurred during the study. In conclusions Tinzaparin have an excellent anticoagulation effect, preventing clotting in dialyser and extracorporeal circuit, without major adverse events, in spite the long time utilization of drug during the procedure.