September 27, 2018 at 12:09 #1661
We are currently in the process for changing our intradialytic anti-coagulation from UFH to tinzaparin. I wanted to see how many other centres have switched over and what their experience has been?
Are other centres administering through the arterial or venous ports? I can only find one resource that says that tinz can be dialyzed out with high flux dialyzers but we are considering trying through the venous port on the theory that tinz could be dialyzed out if administered arterial so perhaps we can get away with a lower dose for effective anti-coagulation. One of our physicians mentioned a paper from Australia (that he can’t find now…) and I can’t find any evidence to support this…
Are other centres using a weight based dose banding approach, a standard starting dose or a UFH conversion?
Look forward to hearing from everyone!
June 4, 2019 at 10:03 #1839
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?
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