Efficacy and Safety of Enoxaparin during Hemodialysis: Results from the HENOX Study
Kriengsak Vareesangthip MD, PhD*, Supachai Thitiarchakul MD**, Inseey Kanjanakul MD***, Vasant Sumethkul MD****, Udom Krairittichai MD*****, Anutra Chittinandana MD******, Derek Bannachak MD*******
Affiliation : * Renal Division, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Nephrology Unit, Department of Medicine, Thammasat Chalermprakiet Hospital, Thammasat University, Bangkok, Thailand *** Renal Division, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand **** Renal Unit, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand ***** Renal Unit, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand ****** Division of Nephrology, Department of Medicine, Bhumibol Adulyadej Hospital, Bangkok, Thailand ******* Renal Division, Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Background : Low molecular weight heparins (LMWHs) have been suggested as an anticoagulant in hemodialysis (HD)
since they provide convenient usage, safety and effective outcomes.
Objective : Determine clinical efficacy and safety of enoxaparin sodium for the anticoagulation effect during HD in 99 clinically
stable end-stage renal disease (ESRD) patients.
Material and Method: This prospective open-label study was conducted in seven hemodialysis centers in Thailand. HD
prescription during the present study was similar to the previous prescriptions including the type of dialyzer. Enoxaparin
sodium 0.7 mg/kg was administered into a pre-dialyzer arterial line at the beginning of the HD session. The anticoagulation
effect was monitored by visual inspection of the HD line hourly and inspection of the dialyzer at the end of HD session.
Vascular access compression time was monitored at both arterial and venous sites separately at the end of the HD.
Results : HD with enoxaparin sodium resulted in no fibrin/clot formation in a hemodialysis line in 97 cases (98%), and no
significant clot formation in a dialyzer in 96 cases (97%). The mean vascular compression time was 5.63 + 1.90 minutes at
the arterial site and 5.72 + 2.61 minutes at the venous site. Neither major adverse events nor major hemorrhages were
reported. Prolonged activated partial thromboplastin times (aPTT) at 30 minutes after hemodialysis were reported in two
cases. These abnormal aPTT cases returned to normal levels within 24 hours and 72 hours, respectively.
Conclusion : The present study suggests that a single-dose regimen of enoxaparin sodium 0.7 mg/kg is an effective, well-
tolerated, and convenient alternative to sodium heparin.
Keywords : Enoxaparin sodium, Hemodialysis, ESRD, Anticoagulant
