Microsoft Word - NEF083BF.rtf

J. Schrader, MD, Department of Nephrology, University Hospital, Robert-Koch-Strasse 40, D-3400 Göttingen (FRG) Dear Sir, We read with interest the recent report of Ponce et al. [1] in this journal on the interference of heparin with peritoneal solute transport. It has shown that intraperitoneal application of standard heparin does not affect or only slightly affects systemic blood coagulation [1–3]. There are, however, no reports dealing with the intraperitoneal use of low molecular weight (LMW) heparin in peritoneal dialysis patients. Several studies have demonstrated that LMW heparin has a powerful antithrombotic effect and high antifactor Xa activity with only a minimal anticoagulant activity as reflected by partial thromboplastin time (PTT) and thrombin time [4–6]. LMW heparin is also a good alternative in hemodialysis and has several advantages over standard heparin [7,8]. We have now been able to demonstrate the systemic effect of intraperitoneally applied LMW heparin Kabi 2165 (Fa. Kabi Vitrum, Sweden) in a 63-years-old male continuous ambulatory peritoneal dialysis (CAPD) patient with deep vein thrombosis of the right thigh and lower leg. Because of the patient’s poor vein condition, the necessary anticoagulant therapy was performed exclusively by intraperitoneal use of LMW heparin. A dose of 8,000 antifactor Xa units/2-liter dialysate bag was given 4 times/day. On the first day, a plasma heparin activity of 0.3 antifactor Xa units/ml was found (measured with the chromogenic substrate S-2222). The therapy was continued with this dose, and a heparin level between 0.5 and 0.8 antifactor Xa units/ml was found during the following 3 months (fig. 1), which in our experience constitutes the therapeutic range. In the 4th and 5th months, the heparin activity rose to 1.15 and 1.35 U/ml, respectively. Therefore the dose was reduced to 6,000 antifactor Xa units/bag, and the heparin activity decreased to 0.82 U/ml (fig. 1). The PTT values had