HIGHER D-DIMER VALUE IN PATIENTS RECEIVING CONTINUOUS HEPARIN COMPARED TO INTERMITTENT HEPARIN DURING REGULAR HAEMODIALYSIS

Derry Heppy Fritiwi, Harun Rasyid Lubis, Adi Koesoema Aman, Herman Hariman

Abstract


Haemodialysis is the most widely used kidney replacement therapy in Indonesia and in the world, but the procedure may trigger development on thrombogenesis. Doe to this reason, anticoagulant heparin is given during haemodialysis to prevent the development of thrombus. However, haemostasis monitoring is essential to predict the possibility of heparin induced bleeding. The use of heparin in general needs a machine to regulate continuous heparin administration, nonetheless not all hospitals have that instruments and for this reasons some centre use intermittent heparin injection. The aim of this study is to investigate whether  intermittent heparin is as effective as continuous heparin to prevent thrombus formation as well as to prevent bleeding and predict the survival outcome. Patient divided in to two grup from intermittent heparin and continuous heparin in total 50 patient were participated. Platelet count, PT, APTT, TT, fibrinogen, and D-dimer were investigated. The result demonstrates that platelet count, PT, APTT, TT, fibrinogen, and D-dimer were not significantly differed between the groups receiving intermittent and continuous heparin (p >0.05). When the test is compared between intermittent and continuous heparin in pre and post haemodialysis it is clear that there is significant increases in APTT and fibrinogen both in the intermittent and continuous heparin, but D-dimer is increased in continuous heparin only during post haemodialysis. There is no difference in the 1-year survival outcome between intermittent and continuous heparin. In conclusion, intermittent heparin produces less D-dimer increase compared to continuous heparin but it is as effective as continuous heparin. Intermittent heparin may be used as the alternative choice when continuous syringe driver machine is not available.


Keywords


Haemostasis, Haemodialysis, Heparin, Chronic Kidney Disease

References


KDIGO (Kidney Disease Improving Global Outcome). 2012. KDIGO 2012 Clinical Practice Guideline for The Evaluation and Management of Chronic Kidney Disease. Kidney Int, 3(Suppl):1-150

Hill NR, et al. 2016. Global Prevalence of Chronic Kidney Disease – A Systematic Review and Meta-Analysisi. Plos One, 11(7):1-18

KDOQI (Kidney Disease Outcome QualityInitiative). 2015. KDOQI Clinical Practice Guideline for Hemodialysis Adequacy. Am J Kidney Dis, 66(5):884-930

Ambuhl PM, Wuthrich RP, Korte W, Schmid L, Krapt R. 1997. Plasma Hypercoagulability in Haemodialysis patients: Impact of Dialysis and Anticoagulation. Nephrology Dialysis Transplantation, 12:2355-2364

Fischer KG. 2007. Essential of Anticoagulation in Hemodialysis. Hemodialysis International, 11:178-189

Roy A, Kalra V. 2012. Anticoagulation In Hemodialysis. Jimsa, 25(2):107-109

Waedle EN. 2002. Anticoagulation for Hemodialysis and Hemofiltration. Saudi J Kidney Dis Transpl, 13(1):40-44

European Renal Association. 2002. Prevention of Clotting in the Haemodialysis Patient with Normal Risk of Bleeding. Nephrology Dialysis and Transplantation, 17:64-66

Rahajuningsih DS. 2012. Patofisiologi Trombosis. In: Hemostasis dan Trombosis. Ed 3. Jakarta:76-82

Shlebak A. 2007. Pathophysiological Aspects of Coagulation. In: Hakim NS, Calero R. Hemostasis in Surgery. Imperial College Press. London:1-90

Perry DJ, Pasi KJ. 2013. Methods in Molecular Medicine: Hemostasis and Thrombosis Protocoals. Humana press Inc. Vol 31. Totowa

Ramaprabha P, Bhuvaneswari T, Kumar RA. 2014. Coagulation Profiles an Indicator of Vascular Haemostatic Function in Chronic Renal Failure Patients Who are on Renal Dialysis. Scholars Journal of Applied Medical Sciences (SJAMS), 2(2B):592-595

Alghytan AK, Alsaeed AH. 2012. Hematological Changes Before and After Hemodialysis. Scientific Research and Essyas, 7(4):490-497




DOI: http://dx.doi.org/10.24293/ijcpml.v25i3.1461

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