Sorry this is a very late response … but it seems most Ontario sites are using dalteparin (Fragmin). I would assume tinzaparin (Innohep) is equally efficacious (used extensively in UK and other parts of Canada).
It would seem logical to go through the arterial port so you’d “coat” the dialysis filter and potentially minimize systemic absorption. But there is good reason to try the venous side to minimize drug wastage.
I’m not aware of any dosing studies comparing arterial VS venous side administration. It might be a great research project … 😉
We originally adopted Toronto Eastern’s weight based protocol when we converted from UFH to LMWH but from our own clinical experience, it seems almost everyone starting hemodialysis tolerates the starting dose 2500 IU of dalteparin regardless of weight. I would assume the starting tinzaparin dose would work equally well.
Good luck with everything.
– Derrick Soong, RPh (Windsor Regional Hospital)
PS What did you end up doing? How did that work out?
