Single-Bolus Tinzaparin Anticoagulation in Extended Hemodialysis Sessions: A Feasibility Study
Bibliographic record
Abstract
Background: Few studies have assessed the use of low-molecular weight heparins for anticoagulation during extended hemodialysis (HD) sessions. This study aimed to evaluate the safety and efficacy of tinzaparin for anticoagulation of the extracorporeal circuit and dialyzer in extended, 8-hour, sessions. Methods: This single-center study included all patients who underwent a single incentre 8-hour session as part of their nocturnal home HD training between 2009 and 2020. Tinzaparin was delivered as a single bolus injection at time 0 with dosing based on the patient's weight and doubling of standard 4-hour session dose. Tinzaparin safety was assessed via anti-Xa measured at 15-, 30-min, 1-, 2-, 4-, 6-, 8-hour. Efficacy was examined via visual observations (score 1-4) of the dialyzer and venous bubble trap at the end of dialysis. Predictors of clotting levels were assessed in exploratory logistic regressions. Results: Forty-seven patients were included: age 45 ±14 yrs, 28% women, 9% on warfarin, 42% on antiplatelets, BMI 29±7 kg/m2, hemoglobin 114±15 g/L and platelet 203±61 109/L. Mean tinzaparin dose was 107 ± 20 IU/kg. Anti-Xa levels peaked at 15-min with 1.3 ± 04 IU/mL and progressively declined reaching 0.9 ± 0.3 IU/mL at 1-hour, 0.4 ± 0.21 IU/mL a 4-hour, and 0.15 ± 0.15 IU/mL after 8-hour. Figure1 After the 8-hour session, none of the patients had severe clotting of their dialyzer or venous chamber. Moderate blood clotting was observed in the dialyzer of 6 (20%) patients and in the venous chamber of 22 (61%) patients. Tinzaparin dose was increased for 27 (81%) patients with a mean maintenance dose of 123 ± 28 IU/kg. None of the main baseline characteristics (including tinzaparin dose per kg) were associated with clotting scores. Conclusions: This study shows that anti-Xa levels stabilize rapidly after administration on tinzaparin for 8-hour HD. Administration of a single bolus tinzaparin at the start of an eight-hour dialysis session appeared safe and effective, although dose adjustment may be required.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".