Korean Journal of Nephrology 1999;18(1):134-140.

저분자량 헤파린이 유지혈액투석시 항응고효과와 지질변수에 미치는 영향 (Effect of Low-Molecular-Weight Heparin on Anticoagulation and Lipid Profiles in Hemodialysis Patients)

박주현, 김미경, 고계자, 이명아, 김병수, 김영옥, 윤선애, 김용수, 방병기 (Joo Hyun Park, Mi Kyoung Kim, Gae Ja Go, Myung Ah Lee, Byung Soo Kim, Young Ok Kim, Sun Ae Yoon, Yong Soo Kim and Byung Kee Bang)

Abstract

Although heparin has over the years proven to be a reliable anticoagulant, there are still several undesirable side effects including dyslipidemia. Several recent publications have suggested that a low-molecular-weight heparin(LMWH) is superior to conventional heparin because it causes less side effects and has beneficial effects on lipid parameters. But the results of the study about lipid parameters are controversial. We conducted a prospective study to evaluate the efficacy, safetey and effect of LMWH on lipid parameters as an anticoagulant in hemodialysis therapy. 2500 aⅩa IU of LMWH(Fragmin ) were given to 51 maintenance hemodialysis patients (age:49.9±16.1, M:F=33:18) just before each dialysis for consecutive 12 hemodialysis. And 16 patients out of 51 patients were given for 6 months to compare the changes of lipid parameters with those in 22 patients with conventional heparin. The mean venous compression time and the degree of clot deposition in dialyzer were similar in both LMWH and conventional heparin group. The heparin concentration via anti-factor Xa-specific clotting method (Heptest ) in both groups was similar(0.64±0.24 vs 0.54±0.18IU/ml at 15 min, 0.32±0.13 vs. 0.26±0.24 IU/ml at 4 hours after starting hemodialysis). The hematologic parameters such as hemoglobin and platelet count level did not show any differences between the two types of heparin. The level of triglyceride was significantly decreased after 6 month by the LMWH therapy(177.6±60.9 vs 145.9±85.5mg/dl, P<0.05) but was not changed by the conventional heparin therapy(150.6±54.6 vs. 176.6±64.6, P=0.16). The level of HDL were significantly changed in both group(32.1±11.6 vs. 37.9±9.7mg/dl, P<0.05 in LMWH group , 40.4±11.9 vs. 33.7±7.8mg/dl, P<0.05 in conventional heparin group). The levels of total cholesterol and LDL-cholesterol were decreased in LMWH group but statistically insignificant. We conclude that LMWH is a suitable alternative to unfractionated conventional heparin for anticoagulation therapy and has beneficial effects on the lipoprotein profile in hemodialysis patients.