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Plasma levels of enoxaparin oligosaccharides, antifactor-Xa and thrombin generation in patients undergoing haemodialysis

Batt, TJ, Lincz, LF, Prasad, R, Patel, RP ORCID: 0000-0001-9344-1013, Shastri, M ORCID: 0000-0002-1012-2779, Lioufas, N, Smith, AG and Jose, MD ORCID: 0000-0002-9589-0071 2020 , 'Plasma levels of enoxaparin oligosaccharides, antifactor-Xa and thrombin generation in patients undergoing haemodialysis' , Blood Coagulation and Fibrinolysis, vol. 31, no. 2 , pp. 152-159 , doi: 10.1097/MBC.0000000000000892.

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Abstract

Lowmolecular weight heparins are used during haemodialysisfor thromboprophylaxis of the dialysis circuit, with plasmaantifactor-Xa (anti-Xa) activity used as a surrogate measure foreffective anticoagulation. However, this pharmacokineticparameter does not always correlate with pharmacodynamiceffects in patients. The aim of this study was to investigate therelationship between actual plasma levels of the lowmolecularweight heparins enoxaparin, anti-Xa activity, and globalcoagulation measurement of thrombin generation duringhaemodialysis. Blood was analysed from 16 adult patients withend-stage kidney disease at 0, 2, 4 h, and at completion of 31dialysis sessions where single fixed doses of 20 (n U 3), 40(n U 16), 60 (n U 6), or 80 (n U 6)mg of enoxaparin (equating to0.23–1.07mg/kg) were used as thromboprophylaxis. Plasmaenoxaparin oligosaccharides [degree of polymerization(dp)6–dp16] were measured by high-performance sizeexclusion chromatography, anti-Xa activity by colourimetricassay, and thrombin generation by calibrated automatedthrombogram. Plasma enoxaparin fragments wereundetectable at the beginning of each dialysis, peaked at 2 h tolevels that correlated with dose (r U 0.68, PP< 0.001). Despite loss of anticoagulant activity in themajorityof patients, plasma levels of enoxaparin oligosaccharidesremained detectable and relatively unchanged throughoutdialysis.

Item Type: Article
Authors/Creators:Batt, TJ and Lincz, LF and Prasad, R and Patel, RP and Shastri, M and Lioufas, N and Smith, AG and Jose, MD
Keywords: anticoagulation, antifactor-Xa, enoxaparin, enoxaparin fragments, haemodialysis, thrombin generation
Journal or Publication Title: Blood Coagulation and Fibrinolysis
Publisher: Lippincott Williams & Wilkins
ISSN: 0957-5235
DOI / ID Number: 10.1097/MBC.0000000000000892
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Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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